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Bedoya MA, Krokhmal AA, Kourmouzi VC, Kwatra NS, Drubach LA, Fehnel KP, Proctor MR, Voss SD. Use of intraoperative bone scintigraphy for resection of spinal osteoid osteoma. Pediatr Radiol 2023; 53:2424-2433. [PMID: 37740781 DOI: 10.1007/s00247-023-05773-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND The location and proximity to the spinal cord in spinal osteoid osteoma can increase the likelihood of an incomplete resection. Intraoperative bone scintigraphy (IOBS) can be used to verify location and complete surgical resection. OBJECTIVE To review our experience using IOBS for resection of intraspinal osteoid osteoma. METHODS IRB approved, retrospective review of IOBS-guided resection over 10 years. Patients underwent injection of 200 uCi/kg (1-20 mCi) 99mTc-MDP 3-4 h prior surgery. Portable single-headed gamma camera equipped with a pinhole collimator (3- or 4-mm aperture) was used. Images were obtained pre-operatively, at the start of the procedure, and intraoperatively. Operative notes were reviewed. Evaluation of recurrence and clinical follow-up was performed. RESULTS Twenty IOBS-guided resections were performed in 18 patients (median age 13.5 years, 6-22 years, 12 males). Size ranged 5-16 mm, with 38.9% (7/18) cervical, 22.2% (4/18) thoracic, 22.2% (4/18) lumbar, and 16.7% (3/18) sacral. In all cases, IOBS was able to localize the lesion. After suspected total excision, IOBS altered the surgical plan in 75% of cases (15/20), showing residual activity prompting further resection. Median length of follow-up was 6 months (range 1-156 months) with 90% (18/20) showing complete resection without recurrence. Two patients had osteoid osteoma recurrence at 7 and 10 months following the original resection, requiring re-intervention. CONCLUSIONS IOBS is a useful tool for real-time localization and assessment of spinal osteoid osteoma resection. In all cases, IOBS was able to localize the lesion and changed surgical planning in 75% of cases. Ninety percent of patients achieved complete resection and remain recurrence free.
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Affiliation(s)
- M Alejandra Bedoya
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Aleksandra A Krokhmal
- Department of Radiology, Mount Auburn Hospital, 330 Mt Auburn St, Cambridge, MA, USA
| | - Vasiliki C Kourmouzi
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Neha S Kwatra
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Laura A Drubach
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Katie P Fehnel
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, , USA
| | - Mark R Proctor
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, , USA
| | - Stephan D Voss
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
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Vita F, Tuzzato G, Pederiva D, Bianchi G, Marcuzzi A, Adani R, Spinnato P, Miceli M, Donati D, Manzetti M, Pilla F, Faldini C. Osteoid Osteoma of the Hand: Surgical Treatment versus CT-Guided Percutaneous Radiofrequency Thermal Ablation. Life (Basel) 2023; 13:1351. [PMID: 37374133 DOI: 10.3390/life13061351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Osteoid osteoma (OO) is one of the most common benign bone tumors. This type of osteogenic tumor is generally characterized by a well-defined lytic area with a vascularized central nidus surrounded by sclerosis and bone thickening. The wrist and hand bones are infrequent sites for osteoid osteoma: only 10% of the cases arise in these areas. Standard treatments are surgical excision and radio-frequency ablation (RFA), both with advantages and disadvantages. This study aimed to compare the two techniques to prove if RFA could be a potential alternative to surgery in the treatment of OO of the hand. (2) Methods: Patients treated for OO of the hand between January 2011 and December 2020 were evaluated and data was collected regarding the lesions' characteristics and the treatment outcome. Each patient was followed up for 24 months and VAS pain (Visual Analogue Scale), DASH (Disability of the Arm, Shoulder and Hand), and PRWE (Patient-Related Wrist Evaluation) scores were collected. (3) Results: A total of 27 patients were included in the study: 19 surgical and 8 RFA. Both treatments showed a significant improvement in pain and functionality. Surgery was associated with a higher complication rate (stiffness and pain), while RFA was associated with a higher recurrence rate (2/8 patients). RFA allowed for a speedier return to work. (4) Conclusions: We believe that osteoid osteoma treatment with RFA in the hand should be an available alternative to surgery as it allows rapid pain relief and a swift return to work. Surgery should be reserved for cases of diagnostic uncertainty or periosteal localization.
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Affiliation(s)
- Fabio Vita
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, 40136 Bologna, Italy
| | - Gianmarco Tuzzato
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, 40136 Bologna, Italy
| | - Davide Pederiva
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, 40136 Bologna, Italy
| | - Giuseppe Bianchi
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, 40136 Bologna, Italy
| | - Augusto Marcuzzi
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, 41124 Modena, Italy
| | - Roberto Adani
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, 41124 Modena, Italy
| | - Paolo Spinnato
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, 40136 Bologna, Italy
| | - Marco Miceli
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, 40136 Bologna, Italy
| | - Danilo Donati
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, 41124 Modena, Italy
| | - Marco Manzetti
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, 40136 Bologna, Italy
| | - Federico Pilla
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, 40136 Bologna, Italy
| | - Cesare Faldini
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, 40136 Bologna, Italy
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Radiofrequency ablation is as safe and effective as surgical excision for spinal osteoid osteoma: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:210-220. [PMID: 36214895 DOI: 10.1007/s00586-022-07411-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Osteoid osteoma (OO) is a primary benign tumor that affects mainly young patients. Ten percent of all OO are located in the vertebral column. Treatment of spinal OO is challenging and there is no consensus in the literature on the best operative approach. PURPOSE The aim of this systematic review and meta-analysis was to determine safety and efficacy of radiofrequency ablation (RFA) versus surgical excision for the treatment of spinal OO. METHODS A literature search was performed on PubMed, Web of Science, and Embase from inception up to 22 March 2022. Studies addressing surgical excision or RFA for the treatment of spinal OO were included. The main outcomes evaluated were pain before and after intervention, the treatments success rate, defined as complete pain relief with no recurrence until the last follow-up, and the number and type of complications. RESULTS Thirty-one studies (749 patients) were included. For patients who underwent surgical excision, 19 studies reported a mean treatment success rate of 85.6%, while in the RFA treatment group, 18 studies reported a mean success rate of 88.6%. At last follow-up, the pooled mean difference in pain scores from baseline on a 0-10 scale was 5.8 points in the surgical excision group and 6.7 points in the RFA group. Recurrences were observed in 5.6% of the patients who underwent surgical excision and in 6.7% of the patients treated with RFA. The complication rate was 7.8% in the surgical excision group and 4.4% in the RFA group. CONCLUSIONS This meta-analysis found high global success rates for both surgical and RFA treatments. Both treatments were efficient in pain relief and presented a low rate of recurrences. The complication rate was low for both treatments. Compared to surgical excision, RFA is a less invasive procedure which proved to be a safe and as effective option for the treatment of spinal OO.
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Amadasu E, Panther E, Lucke-Wold B. Characterization and Treatment of Spinal Tumors. INTENSIVE CARE RESEARCH 2022; 2:76-95. [PMID: 36741203 PMCID: PMC9893847 DOI: 10.1007/s44231-022-00014-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/03/2022] [Indexed: 02/07/2023]
Abstract
The prevalence of spinal tumors is rare in comparison to brain tumors which encompass most central nervous system tumors. Tumors of the spine can be divided into primary and metastatic tumors with the latter being the most common presentation. Primary tumors are subdivided based on their location on the spinal column and in the spinal cord into intramedullary, intradural extramedullary, and primary bone tumors. Back pain is a common presentation in spine cancer patients; however, other radicular pain may be present. Magnetic resonance imaging (MRI) is the imaging modality of choice for intradural extramedullary and intramedullary tumors. Plain radiographs are used in the initial diagnosis of primary bone tumors while Computed tomography (CT) and MRI may often be necessary for further characterization. Complete surgical resection is the treatment of choice for spinal tumors and may be curative for well circumscribed lesions. However, intralesional resection along with adjuvant radiation and chemotherapy can be indicated for patients that would experience increased morbidity from damage to nearby neurological structures caused by resection with wide margins. Even with the current treatment options, the prognosis for aggressive spinal cancer remains poor. Advances in novel treatments including molecular targeting, immunotherapy and stem cell therapy provide the potential for greater control of malignant and metastatic tumors of the spine.
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Affiliation(s)
- Efosa Amadasu
- School of Medicine, University of South Florida, Tampa, USA
| | - Eric Panther
- Department of Neurosurgery, University of Florida, Gainesville, USA
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Papalexis N, Peta G, Ponti F, Tuzzato G, Colangeli M, Facchini G, Spinnato P. CT-Guided Radiofrequency Thermal Ablation for the Treatment of Atypical, Early-Onset Osteoid Osteoma in Children Younger than 4 Years Old: Single-Institution Experience and Literature Review. Diagnostics (Basel) 2022; 12:diagnostics12112812. [PMID: 36428872 PMCID: PMC9689092 DOI: 10.3390/diagnostics12112812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/10/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
Abstract
The aim of our study is to report our experience on CT-guided radiofrequency ablation (RFA) for osteoid osteoma (OO) in children under 4 years of age and to review the literature regarding this atypical, early onset of the disease. We retrospectively reviewed the clinical and radiological records of the patients treated with CT-guided RFA for OO at our institution (2006−2021), including those under 4 years of age. Data regarding technical success, clinical success, and biopsy diagnostic yield were collected. Moreover, we performed a literature review including previous articles on early-onset OO. We found only 12 patients that were under 4 years of age (12/842−1.4%) at the time of RFA treatment: 4 F and 8 M, mean age at the time of the treatment 35.3 months (range 22−46 months). The mean follow-up was 22.8 months (range 6−96 months). Technical success was achieved in all cases (12/12). In all patients (12/12), a complete remission of the pain symptoms was achieved at clinical follow-up controls. No recurrence of pain or complications were documented. The histopathological diagnosis was confirmed in 4 patients (4/12−33.3%). Moreover, we found another 9 articles in the literature with a main focus on early-onset OO (<4 years old), with a total of 12 patients included; 6 of those patients (6/12−50%) were treated with CT-guided RFA, with success reported 5 cases (5/6−83.3%). Our series of cases treated at a single institution, together with the existing data from the literature, confirms that CT-guided RFA is effective and safe for the treatment of osteoid osteoma, even in atypical, early onset in children under 4 years of age.
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Affiliation(s)
- Nicolas Papalexis
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giuliano Peta
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Gianmarco Tuzzato
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Colangeli
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Correspondence: or
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Cerny J, Soukup J, Cerna S, Novotny T. Current Approaches to Osteoid Osteoma and Minimally Invasive Surgery-A Minireview and a Case Report. J Clin Med 2022; 11:jcm11195806. [PMID: 36233673 PMCID: PMC9572602 DOI: 10.3390/jcm11195806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/09/2022] [Accepted: 09/27/2022] [Indexed: 11/21/2022] Open
Abstract
Osteoid osteoma is a benign bone tumor typically affecting the long bones of the lower limbs in young male patients. The lesion can be asymptomatic but, in most cases, patients present with characteristic nocturnal pain that is very responsive to the administration of non-steroidal anti-inflammatory drugs. Although osteoid osteomas can regress spontaneously over time, surgical therapy is often indicated in cases of long-lasting resistant pain. Apart from a traditional open resection, the modalities of minimally invasive surgery, such as radiofrequency ablation or cryoablation, have gradually become the option of choice in most cases. The first part of this manuscript is a minireview of the contemporary literature on the pathogenesis, diagnosis, and current trends in the treatment of osteoid osteoma. The second part is a case report of our own experience with a conventional C-arm-guided radiofrequency ablation of an osteoid osteoma located in the femoral neck in an adolescent patient. The aim was to prove that, even when more sophisticated guiding devices (CT, O-arm, etc.) are not available, the safe and reliable ablation of the lesion using a C-arm is still possible even in hard-to-reach areas. The case was a success, with no perioperative or postoperative complications.
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Affiliation(s)
- Jan Cerny
- Department of Orthopaedics, University J.E. Purkinje and Masaryk Hospital, 401 13 Usti nad Labem, Czech Republic
| | - Jan Soukup
- Department of Orthopaedics, University J.E. Purkinje and Masaryk Hospital, 401 13 Usti nad Labem, Czech Republic
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, 150 06 Prague, Czech Republic
| | - Sarka Cerna
- Department of Genetics, University J.E. Purkinje and Masaryk Hospital, 401 13 Usti nad Labem, Czech Republic
| | - Tomas Novotny
- Department of Orthopaedics, University J.E. Purkinje and Masaryk Hospital, 401 13 Usti nad Labem, Czech Republic
- Correspondence: ; Tel.: +420-4-7711-3050
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Chitta S, Russo TL, Albert AJ, Russo SS, MacFarlane JJ, Janish TJ. En Bloc Resection of Cervical Spine Osteoid Osteoma With O-Arm-Assisted 3D Navigation: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00031. [PMID: 36049033 DOI: 10.2106/jbjs.cc.21.00630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 22-year-old man presented with long-standing, progressive neck pain of unknown etiology. Investigation revealed a cervical spine osteoid osteoma affecting the right C4-5 facet joint. He underwent minimally invasive en bloc resection with O-arm-assisted 3-dimensional navigation without introducing iatrogenic spinal instability. Symptoms resolved after surgery, without recurrence or instability at the 2-year follow-up. CONCLUSION Cervical spine osteoid osteoma is a tumor that presents diagnostic and therapeutic challenges. Achieving precise, complete resection of the tumor with a minimally invasive approach while avoiding spinal instrumentation and arthrodesis is paramount to excellent surgical outcomes.
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Affiliation(s)
- Shashank Chitta
- Spectrum Health/Michigan State University Orthopaedic Surgery Residency, Grand Rapids, Michigan
| | | | - Andrew J Albert
- Spectrum Health/Michigan State University Orthopaedic Surgery Residency, Grand Rapids, Michigan
| | - Scott S Russo
- Spectrum Health-Department of Orthopaedic Surgery, Grand Rapids, Michigan
| | | | - Tyler J Janish
- Spectrum Health/Michigan State University Orthopaedic Surgery Residency, Grand Rapids, Michigan
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Sagoo NS, Haider AS, Chen AL, Vannabouathong C, Larsen K, Sharma R, Palmisciano P, Alamer OB, Igbinigie M, Wells DB, Aoun SG, Passias PG, Vira S. Radiofrequency ablation for spinal osteoid osteoma: A systematic review of safety and treatment outcomes. Surg Oncol 2022; 41:101747. [PMID: 35358911 DOI: 10.1016/j.suronc.2022.101747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/06/2022] [Accepted: 03/22/2022] [Indexed: 12/13/2022]
Abstract
AIM We sought to systematically assess and summarize the available literature on the clinical outcomes and complications following radiofrequency ablation (RFA) for painful spinal osteoid osteoma (OO). METHODS PubMed, Scopus, and CENTRAL databases were searched in accordance with PRISMA guidelines. Studies with available data on safety and clinical outcomes following RFA for spinal OO were included. RESULTS In the 14 included studies (11 retrospective; 3 prospective), 354 patients underwent RFA for spinal OO. The mean ages ranged from 16.4 to 28 years (Females = 31.3%). Lesion diameters ranged between 3 and 20 mm and were frequently seen in the posterior elements in 211/331 (64%) patients. The mean distance between OO lesions and neural elements ranged between 1.7 and 7.4 mm. The estimated pain reduction on the numerical rating scale was 6.85/10 (95% confidence intervals [95%CI] 4.67-9.04) at a 12-24-month follow-up; and 7.29/10 (95% CI 6.67-7.91) at a >24-month follow-up (range 24-55 months). Protective measures (e.g., epidural air insufflation or neuroprotective sterile water infusion) were used in 43/354 (12.1%) patients. Local tumor progression was seen in 23/354 (6.5%) patients who were then successfully re-treated with RFA or open surgical resection. Grade I-II complications such as temporary limb paresthesia and wound dehiscence were reported in 4/354 (1.1%) patients. No Grade III-V complications were reported. CONCLUSION RFA demonstrated safety and clinical efficacy in most patients harboring painful spinal OO lesions. However, further prospective studies evaluating these outcomes are warranted.
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Affiliation(s)
- Navraj S Sagoo
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ali S Haider
- Texas A&M University College of Medicine, Bryan, TX, USA
| | - Andrew L Chen
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA
| | | | - Kylan Larsen
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ruhi Sharma
- Ross University School of Medicine, Miramar, FL, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Othman Bin Alamer
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Matthew Igbinigie
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter G Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Shaleen Vira
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Filippiadis D, Mavrogenis A, Spiliopoulos S, Palialexis K, Brountzos E, Kelekis A. Percutaneous computed tomography-guided radiofrequency ablation of a spinal osteoid osteoma abutting the dura: a case report and review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2021; 31:1625-1630. [PMID: 33709268 DOI: 10.1007/s00590-021-02922-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/25/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Osteoid osteomas in the spine constitute a challenging group for both surgical and percutaneous approaches. Purpose of the present study is to report a case report of a spinal osteoid osteoma in a challenging spinal location and review literature for safety and efficacy of the technique. METHODS We report a case of spinal osteoid osteoma extending in the epidural space and abutting the dura in a pediatric patient treated by percutaneous computed tomography-guided radiofrequency ablation. This is not a systematic review of the literature. A number of separate literature searches were performed. Non-English studies and case reports were excluded from the study. All references of the obtained articles were also evaluated for any additional information. RESULTS Although all prophylactic measures were taken (hydrodissection, thermocouples and neurophysiologic monitoring) and the procedure was uneventful, patient within three hours, was unable to raise or bend the unilateral lower extremity below the knee. Pain reduction was significant from the first morning post-ablation and during the follow-up period of 18 months. MR scan was within normal limits. Dexamethasone was iv injected for 24 h and prescribed per os for 7 days. At follow-up 1 week later mobility of the lower extremity had returned to normal. CONCLUSION As far as spine ablation is concerned, all prophylactic measures should be taken; neurophysiologic monitoring seems to be more sensitive than temperature measurement. Intravenous and per os corticosteroids are extremely useful in case of nerve damage.
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Affiliation(s)
- D Filippiadis
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 1 Rimini str, 12462, Haidari/Athens, Greece.
| | - A Mavrogenis
- A Orthopedic Clinic, University General Hospital "ATTIKON", Athens, Greece
| | - S Spiliopoulos
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 1 Rimini str, 12462, Haidari/Athens, Greece
| | - K Palialexis
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 1 Rimini str, 12462, Haidari/Athens, Greece
| | - E Brountzos
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 1 Rimini str, 12462, Haidari/Athens, Greece
| | - A Kelekis
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 1 Rimini str, 12462, Haidari/Athens, Greece
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Brunori A, Delitala A. Non-Compressive, Disabling, Cervical Radiculopathy and Neck Pain: Cave Osteoid Osteoma. Cureus 2021; 13:e15209. [PMID: 34178528 PMCID: PMC8221648 DOI: 10.7759/cureus.15209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Cervical radiculopathy is a common clinical condition with an annual incidence of 85/10,000. Refractory cases with positive disco-vertebral imaging findings are routinely referred to the Neurosurgeon for evaluation and treatment. In the absence of a clearcut compressive etiology, other rarer but surgically curable causes must be considered before recommending conservative management. We discuss the case of an otherwise active, healthy patient with an invalidating, refractory, relapsing nuchal pain and cervical radiculopathy. Only careful and state-of-the-art neuroimaging led to the correct diagnosis: an osteoid osteoma of the right C6 lamina was diagnosed and microsurgically resected allowing complete recovery and cure. The clinical features of these rare tumors in this unusual location are reviewed. The case is relevant for multifold reasons: it draws attention to rare conditions which can mimic radicular compression; emphasizes the need for a careful evaluation and appreciation of specific clinical symptoms and signs associated with non-compressive radiculopathies; prompts planning of a state of the art imaging workup, in order to rule out such an elusive tumor. All these measures minimize the risk of overlooking the present and other rare pathologies, sparing patients a long path of time-consuming, frustrating and cost-ineffective studies and treatment modalities.
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Parmeggiani A, Martella C, Ceccarelli L, Miceli M, Spinnato P, Facchini G. Osteoid osteoma: which is the best mininvasive treatment option? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1611-1624. [PMID: 33839926 PMCID: PMC8578134 DOI: 10.1007/s00590-021-02946-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/21/2021] [Indexed: 01/21/2023]
Abstract
Osteoid osteoma is the third most common benign bone tumor, with well-known clinical presentation and radiological features. Although surgical excision has been the only therapeutic option for a long time, to date it has been replaced by minimally invasive techniques, which proved satisfactory success rates and low complication occurrence. Therefore, the purpose of this literature review was to describe the main updates of these recent procedures in the field of interventional radiology, with particular attention paid to the results of the leading studies relating to the efficacy, complications, and recurrence rate. Nevertheless, this study aimed to analyze the peculiarities of each reported technique, with specific focus on the possible improvements and pitfalls. Results proved that all mininvasive procedures boast a high success rate with slight number of complications and a low recurrence rate. Radiofrequency ablation is still considered the gold standard procedure for percutaneous treatment of osteoid osteoma, and it has the possibility to combine treatment with a biopsy. Interstitial laser ablation's advantages are the simplicity of use and a lower cost of the electrodes, while cryoablation allows real-time visualization of the ablated zone, increasing the treatment safety. Magnetic resonance-guided focused ultrasound surgery is the most innovative non-invasive procedure, with the unquestionable advantage to be radiation free.
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Affiliation(s)
- Anna Parmeggiani
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1-40136, Bologna, Italy.
| | - Claudia Martella
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1-40136, Bologna, Italy
| | - Luca Ceccarelli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1-40136, Bologna, Italy.,U.O. Di Radiologia, Ospedale degli Infermi, Azienda AUSL Della Romagna, Faenza, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1-40136, Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1-40136, Bologna, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1-40136, Bologna, Italy
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Meng L, Zhang X, Xu R, Wu B, Zhang X, Wei Y, Li J, Shan H, Xiao Y. A preliminary comparative study of percutaneous CT-guided cryoablation with surgical resection for osteoid osteoma. PeerJ 2021; 9:e10724. [PMID: 33520471 PMCID: PMC7812921 DOI: 10.7717/peerj.10724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/16/2020] [Indexed: 12/28/2022] Open
Abstract
Background The traditional treatment for osteoid osteoma is the nidus’ surgical resection, which was difficult to eradicate with more invasive and complications because of osteosclerosis surrounding the nidus. This study aimed to analyze the efficacy and safety of percutaneous CT-guided cryoablation of osteoid osteoma at different sites (especially refractory sites such as the spine). Methods Fifteen patients with osteoid osteoma who underwent cryoablation at our institution were analyzed retrospectively on their imaging data and clinical visual analog scale (VAS) pain scores before and after the procedure. Fifty-three patients underwent surgical resection during the period were also included in this study as a control group. Treatment efficacy was assessed primarily by comparing the differences in VAS scores at different time points in each group of patients by paired-sample t-test. Differences in length of hospital stay and complications between the two groups were also compared. Results The technical success rate was 100% in both the cryoablation and surgical resection group. Cryoablation had a significantly shorter hospitalization time than surgery (p = 0.001). Clinically, the post-operative VAS scores were all significantly improved compared to the pre-operative period, and the clinical cure was achieved in both groups. Surgical operations had more complications than cryoablation, although there was no significant difference. In the group of cryoablation, only one patient had mild numbness of the left lower extremity, which relieved itself; two patients had mild post-operative pain. No patients in the cryoablation group experienced recurrence during the follow-up period. In the surgery group, three of the patients experienced massive bleeding (>500 ml), and two underwent transfusion therapy. Only one patient in the surgical resection group experienced a recurrence at 29 months postoperatively and underwent a second resection. All patients had local scars on the skin after surgical resection. Conclusion Cryoablation is a minimally invasive, safe, and effective treatment strategy for osteoid osteoma, and is fully comparable to surgical resection.
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Affiliation(s)
- Liangliang Meng
- Medical School of Chinese PLA, Beijing, China.,Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.,Department of Radiology, Chinese PAP Beijing Corps Hospital, Beijing, China
| | - Xiao Zhang
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Ruijiang Xu
- Department of Pediatric Surgery, Chinese PLA General Hospital, Beijing, China
| | - Bin Wu
- Department of Radiology, Chinese PAP Beijing Corps Hospital, Beijing, China
| | - Xiaobo Zhang
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yingtian Wei
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jing Li
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Husheng Shan
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yueyong Xiao
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
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