Spine osteoid osteoma can be a challenging diagnosis. Radiating pain to thorax, abdomen or thigh due to radiculopathy is known to mislead diagnostic path to non-orthopedic conditions.

This is the cause of delayed diagnoses and treatments. Therefore, osteoid osteoma should be considered when a nocturnal recurrent pain finds no diagnostic resolution. Gastrointestinal symptoms have never been described as cause of misdiagnosis in spine osteoid osteoma. This a case of a 17-year-old girl with recurrent nocturnal back pain with epigastric discomfort, abdominal distension and nausea due to a D12 spine osteoid osteoma. The patient underwent a 12-month diagnostic path for gastroenterological, nephrological and gynecological causes of abdominal pain before reaching the correct diagnosis.

Bone scintigraphy and thin slices (0.2 mm) CT scan revealed the spine osteoid osteoma in the left articular process of D12 confirmed by histology. CT guided radiofrequency of the lesion lead to a resolution of symptoms. Further investigations revealed Helicobacter pylori infection and small intestinal bacterial overgrowth proving that gastrointestinal symptoms were present only when osteoid osteoma was active despite the persistence of bacterial infection. Therefore, hypothesis of spine conditions revealing gastrointestinal diseases due to alteration of microbiota physiology is investigated.

Nocturnal recurrent pain and painful scoliosis should rise the suspicion of spine osteoid osteoma. As shown in this case, even in the absence of radiculopathy, gastrointestinal symptoms can be present and can mislead diagnosis. Moreover, when back symptoms are associated with epigastric discomfort, abdominal distension and nausea, breath tests should be performed in order to avoid missing diagnosis of Helicobacter pylori infection and SIBO.