Osteoid Osteoma: CT-guided Percutaneous Radiofrequency Ablation and Follow-up in 47 Patients

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PURPOSE

To evaluate computed tomography (CT)-guided radiofrequency (RF) ablation as a minimally invasive therapy for osteoid osteoma with regard to technical and clinical success and immediate and delayed complications.

MATERIALS AND METHODS

Forty-seven patients (age range, 8–41 y; mean age, 19.6 y) with osteoid osteomas (femur, n = 25; tibia, n = 15; pelvis, n = 2; humerus, n = 1; ulna, n = 1; talus, n = 1; calcaneus, n = 1; vertebral body, n = 1) were treated with CT-guided RF ablation in 15 cases after one (n = 10) or two (n = 5) unsuccessful attempts at open surgical resection. Percutaneous therapy was performed with use of general or spinal anesthesia. After localization of the nidus with 1–3-mm CT sections, osseous access was established with either a 2-mm coaxial drill system or an 11-gauge Jamshidi needle. RF ablation was performed at 90°C for a period of 4–5 minutes with use of a rigid RF electrode with a diameter of 1 mm. The procedures were regarded as technically successful if the tip of the RF electrode could be placed within the center of the nidus and could be heated to the desired temperature. Clinical success of treatment was defined as permanent relief of pain and return to normal function without additional treatment. In case of persistence or recurrence of symptoms after RF ablation, treatment was regarded as secondarily successful if permanent relief of symptoms could be achieved in a second procedure.

RESULTS

All procedures were technically successful. Clinical success was achieved in 94% of patients (44 of 47). Three patients had recurrence of pain 3, 5, and 7 months after treatment, respectively (mean observation interval, 22 mo). All recurrences were treated successfully in a second procedure (secondary success rate, 100%). No immediate or delayed complications were observed.

CONCLUSION

CT-guided percutaneous RF ablation is a simple, minimally invasive, safe and highly effective technique for treatment of osteoid osteoma.

Section snippets

Patients

From March 1997 to October 1999, 47 patients (female, n = 13; male, n = 34), aged 8–41 years (mean age, 19.6 y), with lesions diagnosed as osteoid osteomas were treated with percutaneous RF ablation. All patients were symptomatic. The duration of pain before RF ablation varied from several months to 2 years. The treatment decision was made after multi-disciplinary discussion between orthopedic surgeons and radiologists on the basis of clinical and radiologic criteria in the setting of a

RESULTS

Percutaneous treatment was technically successful in all cases, and no immediate complications were encountered during or after the procedures. After recovery from anesthesia, postprocedural pain was prevented by one infusion of intravenous analgesics. All patients could be discharged after 24 hours of hospitalization. Mild to moderate pain during the subsequent few days could be controlled sufficiently with oral analgesics. All 47 patients were pain-free within 1 week after RF ablation.

DISCUSSION

The present study, to our knowledge, represents the largest series of percutaneously treated osteoid osteomas reported thus far. Clinically successful treatment was performed in 94% of patients primarily and 100% of patients secondarily (after a second RF ablation procedure in the three patients with recurrences). These results are comparable with those reported by other authors, who investigated RF ablation of osteoid osteoma in a limited number of patients (N = 3–18) and achieved primary

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