Full-endoscopic pedicle-based approach for resection of osteoid osteoma in the lumbar spine: a case report and review of current literature.

Background: Osteoid osteoma (OO) of the spine is a rare benign tumor that can cause significant pain and radiculopathy, particularly when the lesion involves the posterior elements such as the pedicle. Although traditional treatments like radiofrequency ablation (RFA) and open surgery are effective, they pose risks including neural injury and spinal instability. In recent years, full-endoscopic spine surgery has emerged as a minimally invasive alternative, offering precise lesion localization and resection while preserving spinal integrity. Case Description: We present the case of a 20-year-old female who reported a 6-month history of progressive low back pain and severe left-sided L5 radiculopathy. Imaging revealed a nidus in the left L5 pedicle consistent with OO. The lesion was successfully resected using a full-endoscopic pedicle-based approach with the RIWOspine system. The procedure was performed under fluoroscopic guidance, allowing direct visualization and excision of the nidus. The patient experienced immediate symptom relief, and postoperative imaging confirmed complete resection. Histopathological examination confirmed the diagnosis of OO. At 1-year follow-up, she remained asymptomatic with no evidence of recurrence or spinal instability. Conclusions: Full-endoscopic pedicle-based resection provides a safe, effective, and minimally invasive technique for managing spinal OOs. This approach offers direct nidus visualization, preservation of spinal stability, and excellent clinical outcomes, supporting its utility as a preferred option in select cases. A literature review further supports its utility as a viable first-line surgical option, particularly in young patients with posterior element lesions. Future studies are needed to validate this technique in larger cohorts and to establish standardized protocols.