1
|
Vogl TJ, Bialek M, Eichler K, Hammerstingl R, Bielfeldt J, Zangos S, Scholtz JE, Adwan H. Short- and Long-Term Outcomes after Radiofrequency Ablation of Osteoid Osteomas. J Pers Med 2024; 14:401. [PMID: 38673028 PMCID: PMC11051171 DOI: 10.3390/jpm14040401] [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: 03/04/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
The aim of this study was to evaluate treatment of osteoid osteomas using bipolar radiofrequency ablation (RFA) and patients' quality of life before and after therapy. We retrospectively evaluated patients who underwent bipolar RFA of osteoid osteomas between 2001 and 2016. We assessed patients' symptoms before and after treatment (four weeks after treatment and long-term) using a questionnaire including severity and quality of pain on a 10-point scale (1 = no pain, 10 = severe pain), motion restrictions, pain-related sleep disorders, and necessary pain medication. In addition, we evaluated technical success, complications, hospitalization length, and patients' satisfaction with treatment. This study included 62 patients (43 [69.4%] males, 26.2 ± 13.2 years). Average nidus size was 5.7 ± 2.6 mm. The rate of technical success was 100%. All RFAs were performed without any complications. One patient showed a recurrence, resulting in a recurrence rate of 1.6%, which was successfully treated by another session of RFA. Average hospitalization length was 1.5 ± 0.5 days. A total of 36 patients (58.1%) participated in the questionnaire, reporting an average pain severity of 8.2 ± 1.6 before RFA compared to 3.4 ± 3.0 four weeks after and an average of 2.1 ± 2.3, 6.6 years after therapy, (both p < 0.001). After therapy, 31 (86.1%) patients had no pain. The majority of patients (n = 34, 94.4%) had reduced or absent motion restriction after therapy (p < 0.001). Patient satisfaction rate was 91.7%. In conclusion, bipolar RFA is a safe and effective treatment modality for osteoid osteomas and improves quality of life by reducing pain severity and motion restrictions.
Collapse
Affiliation(s)
- Thomas J. Vogl
- Clinic for Radiology and Nuclear Medicine, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.B.)
| | | | | | | | | | | | | | | |
Collapse
|
2
|
Rajasekaran RB, Krishnamoorthy V, Kamashi J, Thippeswamy PB, Singh R, Rajasekaran S. Is Intraoperative CT Navigation feasible for excision of osteoid osteoma in the appendicular skeleton? - Retrospective analysis of 58 cases. J Orthop 2024; 47:28-34. [PMID: 38022841 PMCID: PMC10679521 DOI: 10.1016/j.jor.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background The use of intraoperative CT navigation to manage osteoid osteoma is not common. We report our experience managing osteoid osteoma in the appendicular skeleton using an intraoperative AIRO CT navigation system. Materials & methods Between May 2013 and December 2022, 59 patients underwent Navigation-assisted excision of osteoid osteoma in the appendicular skeleton. Our primary study outcome was to assess for recurrence of the tumour with recurrence of symptoms. For our secondary outcomes, we evaluated the complications associated with the procedure and evaluated the histological slides of all patients to see for the presence of nidus. Results Of the 58 patients available for review, no patient had a lesion recurrence, and all were symptom-free at an average follow-up of 45.6 months (6-100). Two patients (3.5%) had a superficial infection managed conservatively, and 43 patients (74.1%) had the presence of nidus in curetted samples. No patient developed a pathological fracture after the procedure. Conclusion Using intraoperative CT navigation to manage osteoid osteoma in the appendicular skeleton is safe, minimally invasive, and effective in completely removing the nidus with a negligible complication rate. The absence of nidus on histology should not be a concern to clinicians once thorough burring and verification of excision of nidus has been confirmed intra-operatively. Study design Retrospective Case Series. Level of evidence Level IV.
Collapse
Affiliation(s)
- Raja Bhaskara Rajasekaran
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Venkatadass Krishnamoorthy
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Jayanthi Kamashi
- Department of Pathology, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Pushpa Bhari Thippeswamy
- Department of Radiology, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Rithika Singh
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Shanmuganathan Rajasekaran
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| |
Collapse
|
3
|
Mahmutoğlu AS, Arslan FZ, Karagülle M, Çakır MS, Mahmutoğlu Ö. The effect of radiofrequency ablation on pain score and non-steroidal painkiller use in osteoid osteoma patients. BMC Med Imaging 2023; 23:160. [PMID: 37853314 PMCID: PMC10585726 DOI: 10.1186/s12880-023-01113-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/29/2023] [Indexed: 10/20/2023] Open
Abstract
AIM CT-guided radiofrequency ablation (RFA) is among the thermal ablative procedures and provides great benefits with a minimally invasive procedure. In this prospective study, we aimed to reveal the significance of a multidisciplinary method in reducing the recurrence and complications in osteoid osteoma patients with CT-guided RFA performed by a team of experts in the field. MATERIALS AND METHODS A total of consecutive 40 patients with osteoid osteoma were prospectively evaluated and treated with CT-guided RFA. Before and the post ablation the visual analog scale (VAS) and use of nonsteroidal anti-inflammatory drugs (NSAIDS) were compared. RESULTS Post-ablation VAS of the patients at the 1st week and 3rd month after the procedure decreased significantly (p < 0.01) compared to the pre-ablation. The frequency of NSAID use after the ablation decreased significantly (p < 0.01) compared to the pre-ablation time. The pre-procedure NSAID use of our patients included in the study was average 6.93 per week, the NSAID use in the 3rd month post-procedure controls was average 0.53 per week. Recurrence was detected in 4 of our patients, 36 patients had complete recovery. CONCLUSION Radiofrequency ablation is an effective treatment method in the management of osteoid osteomas. Radiofrequency ablation has low recurrence rates and provides rapid regression in patients' pain after treatment.
Collapse
Affiliation(s)
| | - Fatma Zeynep Arslan
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Turkey
| | - Mehmet Karagülle
- Department of Radiology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Semih Çakır
- Department of Radiology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Özdeş Mahmutoğlu
- Department of Radiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
4
|
Liu R, Tian J, Yuan J, Zhao B, Xu C, Wang Y. Computer-Assisted Navigation Full Visualization Spinal Endoscopic Surgery for Lumbar Vertebral Osteoid Osteoma. Orthop Surg 2023; 15:2464-2470. [PMID: 37344980 PMCID: PMC10475676 DOI: 10.1111/os.13801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Osteoid osteoma is a benign osteogenic tumor that occurs mostly in the femoral stem, while osteoid osteoma occurring in the lumbar vertebral body is a relatively rare case. To minimize treatment-related complications, a computer-assisted navigation fully visualized spinal endoscopy was used. Ultimately, the pathology was diagnosed as osteoid osteoma. CASE PRESENTATION We report a 19-year-old adult male with low back pain that worsened at night and CT, MRI imaging showed an abnormal signal shadow at the posterior margin of the lumbar vertebral body. Due to the proximity of the lesion to the spinal canal and adjacent to the nerve roots, it was difficult to precisely localize the lesion by purely endoscopic or open procedures, and if necessary, the resection of surrounding tissues had to be expanded, causing unnecessary damage to the surrounding tissues. Therefore, we choose computer-assisted navigation fully visualized spinal endoscopy to perform the treatment. CONCLUSION In this case, we report an osteoid osteoma that occurs less frequently in the lumbar vertebral body. Using computer-assisted navigation with fully visualized spinal endoscopy, we successfully resected the osteoid osteoma at the posterior margin of the L3 vertebral body preoperatively by computer-planned path with intraoperative visualization endoscopy, minimizing the damage to spinal stability. Computer-assisted navigation with visualization endoscopy provides a more precise and minimally invasive approach to the treatment of osteoid osteoma of the spine.
Collapse
Affiliation(s)
- Ruxing Liu
- Department of OrthopaedicThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Jingyuan Tian
- Department of Biochemistry and Molecular BiologySchool of Basic Medical Sciences, Shanxi Medical UniversityTaiyuanChina
| | - Jie Yuan
- Department of OrthopaedicThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Bin Zhao
- Department of OrthopaedicThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Chaojian Xu
- Department of OrthopaedicThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Yongfeng Wang
- Department of OrthopaedicThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Efthymiadis A, Tsikopoulos K, Uddin F, Kitridis D, Edwards N, Sidiropoulos K, Lavalette D. Which is the optimal minimally invasive treatment for osteoid osteoma of the hip? A systematic review and proportional meta-analysis. J Orthop Sci 2022; 27:456-462. [PMID: 33563522 DOI: 10.1016/j.jos.2020.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/29/2020] [Accepted: 12/07/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Osteoid osteomata comprise approximately 10% of benign bone tumours, with 20% of them being located in the proximal femur and 1-3% in the pelvis. In this meta-analysis, we sought to investigate positive and negative outcomes relating to minimally invasive surgery (MIS), which has superseded open resection and conservative measures over the last decades. METHODS We searched the PubMed, CENTRAL and grey literature for completed studies published until 10 August 2020. Articles with a minimum of ten patients diagnosed with osteoid osteomata of the proximal femur and/or acetabulum were included. Primary outcomes were success rates, complications and recurrences following treatment. Delays in diagnosis were also recorded. We conducted random effects meta-analysis of success rates for MIS modalities using MedCalc statistical software. Quality was assessed with a modified Delphi checklist. RESULTS Sixteen case-series were identified. Success rates for computed-tomography (CT)-guided radiofrequency ablation (RFA), CT-guided percutaneous resection drilling and arthroscopic resection were 98.2% (95% CI 95.8-99.5), p = 0.47; 91.5% (95% CI 81.1-97.9), p = 0.06; and 98% (95% CI 89.3-99.7), p = 0.95, respectively. Both RFA and percutaneous drilling resection were associated with two iatrogenic femoral fractures. Arthroscopic removal was not associated with any complications. Definitive diagnosis was established at least six months after symptom onset in up to 43% of patients. CONCLUSIONS RFA could be the most effective treatment options for patients suffering from osteoid osteomata of the hip. Arthroscopy could be potentially as effective as RFA as long as further large-scale studies confirm its efficacy and safety. Reported complications stemming from these modalities were sparse in nature. In order to avoid inordinate diagnostic delays, a high index of suspicion and low threshold for CT scan investigation is required.
Collapse
Affiliation(s)
| | | | - Farid Uddin
- Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom
| | - Dimitrios Kitridis
- 1st Orthopaedic Department of Aristotle University G. Papanikolaou General Hospital, Exohi, Thessaloniki, Greece
| | - Nicholas Edwards
- Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom
| | | | - David Lavalette
- Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom
| |
Collapse
|
7
|
Izzo A, Zugaro L, Fascetti E, Bruno F, Zoccali C, Arrigoni F. Management of Osteoblastoma and Giant Osteoid Osteoma with Percutaneous Thermoablation Techniques. J Clin Med 2021; 10:jcm10245717. [PMID: 34945013 PMCID: PMC8709302 DOI: 10.3390/jcm10245717] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/27/2021] [Accepted: 12/03/2021] [Indexed: 12/23/2022] Open
Abstract
Osteoblastoma (OB) is a rare, benign bone tumor, accounting for 1% of all primary bone tumors, which occurs usually in childhood and adolescence. OB is histologically and clinically similar to osteoid osteoma (OO), but it differs in size. It is biologically more aggressive and can infiltrate extraskeletal tissues. Therapy is required because of severe bone pain worsening at night. Moreover, non-steroid anti-inflammatory drugs (NSAIDs) are not a reasonable long-term treatment option in young patients. Surgical excision, considered the gold standard in the past, is no longer attractive today due to its invasiveness and the difficulty in performing a complete resection. The treatment of choice is currently represented by percutaneous thermoablation techniques. Among these, Radiofrequency ablation (RFA) is considered the gold standard treatment, even when the lesions are located in the spine. RFA is a widely available technique that has shown high efficacy and low complication rates in many studies. Other percutaneous thermoablation techniques have been used for the treatment of OB, including Cryoablation (CA) and laser-ablation (LA) with high success rates and low complications. Nevertheless, their role is limited, and further studies are necessary.
Collapse
Affiliation(s)
- Antonio Izzo
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (E.F.); (F.B.)
- Correspondence:
| | - Luigi Zugaro
- Department of Emergency and Interventional Radiology, San Salvatore Hospital, 67100 L’Aquila, Italy; (L.Z.); (F.A.)
| | - Eva Fascetti
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (E.F.); (F.B.)
| | - Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (E.F.); (F.B.)
| | - Carmine Zoccali
- Orthopaedics and Traumatology Unit, Policlinico Umberto I, Sapienza University of Rome, 00185 Roma, Italy;
| | - Francesco Arrigoni
- Department of Emergency and Interventional Radiology, San Salvatore Hospital, 67100 L’Aquila, Italy; (L.Z.); (F.A.)
| |
Collapse
|
8
|
Smolle MA, Gilg MM, Machacek F, Smerdelj M, Tunn PU, Mavcic B, Lujic N, Sopta J, Repsa L, Igrec J, Leithner A, Bergovec M. Osteoid osteoma of the foot : Presentation, treatment and outcome of a multicentre cohort. Wien Klin Wochenschr 2021; 134:434-441. [PMID: 34735614 PMCID: PMC9213275 DOI: 10.1007/s00508-021-01966-0] [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: 08/27/2021] [Accepted: 10/05/2021] [Indexed: 11/07/2022]
Abstract
Background Osteoid osteomas of the foot are rare, with a varying and atypical clinical as well as radiological presentation impeding early diagnosis and treatment. The aim of the present multicentre study was to 1) analyze epidemiological, clinical and radiological findings of patients with foot osteoid osteomas and to 2) deduce a diagnostic algorithm based on the findings. Methods A total of 37 patients (25 males, 67.6%, mean age 23.9 years, range 8–57 years) with osteoid osteomas of the foot were retrospectively included, treated between 2000 and 2014 at 6 participating tertiary tumor centres. Radiographic images were analyzed, as were patients’ minor and major complaints, pain relief and recurrence. Results Most osteoid osteomas were located in the midfoot (n = 16) and hindfoot (n = 14). Painful lesions were present in all but one patient (97.3%). Symptom duration was similar for hindfoot and midfoot/forefoot (p = 0.331). Cortical lesions required fewer x‑rays for diagnosis than lesions at other sites (p = 0.026). A typical nidus could be detected in only 23/37 of x‑rays (62.2%), compared to 25/29 CT scans (86.2%) and 11/22 MRIs (50%). Aspirin test was positive in 18/20 patients (90%), 31 patients (83.8%) underwent open surgery. Pain relief was achieved in 34/36 patients (outcome unknown in one), whilst pain persisted in two patients with later confirmed recurrence. Conclusions As previously reported, CT scans seem to be superior to MRIs towards detection of the typical nidus in foot osteoid osteomas. In patients with unclear pain of the foot and inconclusive x‑rays, osteoid osteoma should be considered as differential diagnosis.
Collapse
Affiliation(s)
- Maria A Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Magdalena M Gilg
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Felix Machacek
- Department of Orthopaedic Surgery, Orthopaedic Hospital Gersthof, Vienna, Austria
| | - Miroslav Smerdelj
- Department of Orthopaedic Surgery, Clinical Hospital Centre Zagreb, Zagreb, Croatia
| | - Per-Ulf Tunn
- Department of Tumour Orthopaedics, HELIOS Klinikum Berlin-Buch, Berlin-Buch, Germany
| | - Blaz Mavcic
- Department of Orthopaedic Surgery, Faculty of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nenad Lujic
- Institute for Orthopedic Surgery Banjica, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Jelena Sopta
- Institute for Orthopedic Surgery Banjica, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Lauris Repsa
- Department of Orthopaedics, Riga Stradins University, Riga, Latvia
| | - Jasminka Igrec
- Department of Radiology, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Marko Bergovec
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| |
Collapse
|
9
|
Pathologic Femur Fracture through Osteoid Osteoma after Radiofrequency Ablation: Case Report and Review of the Literature. Case Rep Orthop 2021; 2021:5560037. [PMID: 34367706 PMCID: PMC8337104 DOI: 10.1155/2021/5560037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/10/2021] [Indexed: 11/17/2022] Open
Abstract
This is a case report of a 4-year-old girl who sustained a femoral shaft fracture 2 weeks after radiofrequency ablation of an osteoid osteoma. The fracture occurred after a relatively low-energy impact, jumping off the second to last step of a staircase. The pathologic fracture was successfully treated with closed reduction and spica casting, with full return to activities. Cases have been reported in the literature of femoral shaft fractures in older patients after radiofrequency ablation, but all are farther out than 2 weeks and none in patients as young as 4 years.
Collapse
|
10
|
Osteoid Osteoma: A Unique Presentation in a Child's Lesser Toe. Case Rep Orthop 2021; 2021:8876584. [PMID: 34367707 PMCID: PMC8337121 DOI: 10.1155/2021/8876584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 06/18/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Osteoid osteoma is an uncommon, small, benign, self-limiting, and usually painful tumor of the skeleton. Diagnosis can be straightforward if seen in the usual locations as the femur and the tibia in young adults, who present with nocturnal pain, alleviated by salicylates. The diagnosis can be more challenging in the spine, pelvis, hand, or feet. Case Report. We report the case of an 11-year-old boy who was treated symptomatically for a painful toe since 10 months, without a definitive diagnosis. X-ray, MRI, and scintigraphy, along with the typical nocturnal pain and swelling of the toe, suggested an osteoid osteoma, confirmed by histology after excisional biopsy of the lesion. Conclusion Osteoid osteoma should always be included in the differential diagnosis when it comes to nocturnal pain without systemic signs, even in unusual places in children. The awareness should lead to a prompt diagnosis and treatment.
Collapse
|
11
|
Gandhi VR, Shanmugasundaram S. A Missed Case of Osteoid Osteoma of the Acetabulum Treated with a Novel Computed Tomography-Guided Technique - A Case Report. J Orthop Case Rep 2021; 10:102-105. [PMID: 34169028 PMCID: PMC8046458 DOI: 10.13107/jocr.2020.v10.i09.1922] [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] [Indexed: 11/30/2022] Open
Abstract
Introduction: Osteoid osteoma is a benign osteoblastic bone tumor that mostly arises from the long bones. The acetabulum is a rare site for osteoid osteoma. Moreover, juxta-articular location of the lesion can be associated with delayed diagnosis. We present a case of a juxta-articular osteoid osteoma of the acetabulum that was missed earlier. We also present a novel, easy, and cost-effective way to accurately localize and excise such a lesion, thereby avoiding failure and recurrence. Case Report: A 15-year-old female presented with a history of insidious onset pain in the right hip for 18 months. Pain was diffuse over the hip. She had undergone a failed biopsy in another hospital. She visited us 1 month later with persistent pain. Examination revealed tenderness over the right anterior hip joint line with painful terminal hip flexion. Computed tomography (CT) suggested an osteoid osteoma of the superolateral acetabular rim. The patient was planned for CT-guided mini-open excision biopsy of the lesion. CT-guided localization of the lesion was performed under local anesthesia in the CT room, followed by open excision of the nidus in the operating room. Histopathology confirmed the diagnosis and a complete excision. At last follow-up at 1 year, the patient was asymptomatic and returned to normal function. Conclusion: Osteoid osteoma of the acetabulum is uncommon and the diagnosis is usually delayed. A high index of suspicion is needed to avoid a missed diagnosis and CT-guided approach can help in accurate excision. Our technique to localize and completely excise the lesion is novel, simple, and cost effective and can be easily replicated.
Collapse
Affiliation(s)
- Vaibhav R Gandhi
- Department of Orthopaedic, Sudarshan Orthocare Hospital, Aurangabad, Maharashtra, India
| | | |
Collapse
|
12
|
Effectiveness and reliability of traditional open surgery in atypical localizations of osteoid osteoma. Jt Dis Relat Surg 2021; 31:541-547. [PMID: 32962587 PMCID: PMC7607951 DOI: 10.5606/ehc.2020.74333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives
This study aims to evaluate traditional open surgery results of osteoid osteomas (OOs) in atypical localizations and explore whether open surgery can be a safe alternative in localizations where radiofrequency ablation (RFA) may not be suitable. Patients and methods
A total of 26 patients (20 males, 6 females; mean age 23.3±14.2 years; range, 4 to 65 years) having OO in atypical localizations between January 2008 and January 2017 were retrospectively evaluated. All patients underwent traditional open surgery under anesthesia. All patients were followed-up, and their clinical success and complications were evaluated. The pain intensity was assessed using the visual analog scale (VAS). Results
The postoperative first year VAS score was 0.2±0.5 (range, 0-2) (p<0.005). None of the patients showed any complications. No recurrences were reported at the end of the first year. All patients were relieved from pain due to OO in atypical localizations. Conclusion Although RFA has been accepted as the preferred treatment for OO, traditional open surgery may still be used for OO in atypical localizations yielding perfect clinical results with fewer complications. It is a safe alternative for localizations such as carpal bones, distal ulna, hand and foot where RFA complications can be seen more frequently. In these localizations, traditional open surgery can be recommended as the first treatment choice.
Collapse
|
13
|
Swank KR, Baker EA, Gehrke CK, Rohde RS. Surgical Management of Triquetral Osteoid Osteoma with Adjunct Tetracycline for Intraoperative Visualization: A Case Report. JBJS Case Connect 2020; 10:e20.00132. [PMID: 33512929 DOI: 10.2106/jbjs.cc.20.00132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report the case of a 15-year-old male patient presenting with persistent wrist pain after surgical treatment of a triquetral osteoid osteoma. The patient was found to have a persistent nidus. These tumors are difficult to observe intraoperatively or through fluoroscopy, limiting adequate resection and resulting in continued pain. CONCLUSION The nidus was excised successfully through an unusual technique using tetracycline for intraoperative identification. The patient remains asymptomatic without recurrence at 31 months postoperative. Difficulties visualizing and removing carpal lesions leading to recurrence are described.
Collapse
Affiliation(s)
- Katherine R Swank
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, Michigan
| | - Erin A Baker
- Department of Orthopaedic Research, Beaumont Health, Royal Oak, Michigan.,Department of Orthopaedic Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Corinn K Gehrke
- Department of Orthopaedic Research, Beaumont Health, Royal Oak, Michigan
| | - Rachel S Rohde
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, Michigan.,Department of Orthopaedic Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| |
Collapse
|
14
|
Onashvili N, Loria G, Gogichaishvili T, Mariamidze A, Sirbiladze M, Sainishvili N. Computed tomography guided radiofrequency ablation of multifocal osteoid osteoma. Radiol Case Rep 2020; 15:1275-1279. [PMID: 32577146 PMCID: PMC7305363 DOI: 10.1016/j.radcr.2020.05.048] [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: 04/28/2020] [Revised: 05/23/2020] [Accepted: 05/24/2020] [Indexed: 11/05/2022] Open
Abstract
Osteoid osteoma is a benign osteoblastic tumor characterized mostly by presence of one nidus, butvery infrequentlyniduses can be multiple. Radiofrequency ablation is a well-established treatment method for this disease. We report a case of a 19-year-old male patient with bifocal osteoid osteoma which was partially missed on the initial magnetic resonance imaging and treated successfully with two sessions of radiofrequency ablation. Following the second session of ablation, the pain resolved immediately and the patient remains pain-free for 6 months since the procedure. Our case report underlines the fact that although very rare, multifocal osteoid osteomas do exist and its niduses can be obscured during the magnetic resonance imaging due to the edema. It emphasizes the role of the initial computed tomography evaluation.
Collapse
Affiliation(s)
- Nikoloz Onashvili
- Department of Interventional Radiology, Tbilisi Central Hospital 1, Konstantine Chachava St, Tbilisi 0159, Georgia
| | - George Loria
- Department of Orthopedic Surgery, Tbilisi Central Hospital, Georgia
| | | | | | | | | |
Collapse
|