Peripheral osteoid osteoma

Atypical Presentation of an Osteoid Osteoma With a Multicentric Nidus

An osteoid osteoma is typically a benign bone tumor affecting young adult males, often presenting with nocturnal pain alleviated by nonsteroidal anti-inflammatory medications (NSAIDS). It usually manifests as a solitary nidus with surrounding sclerosis. An osteoid osteoma with a multicentric nidus, characterized by multiple nidi, is a rare variant. A 12-year-old girl presented with a one-year history of worsening, nighttime pain in her upper left leg. Plain radiographs revealed two lytic lesions with sclerosis. A computed tomography (CT) scan confirmed two well-defined sclerotic lesions with central lytic lesions. Magnetic resonance imaging (MRI) demonstrated two hypointense lesions with peripheral hyperintensity on short tau inversion recovery (STIR) sequences, suggestive of osteoid osteoma with a multicentric nidus. Differential diagnoses included osteomyelitis with Brodie's abscess, osteoblastoma, chondroblastoma, and malignant lesions. Due to the atypical presentation and lack of experience with radiofrequency ablation (RFA) for multicentric cases, surgical excision was performed. Histopathology confirmed osteoid osteoma. After rehabilitation, the patient was asymptomatic at six months with no recurrence on radiographs. This case highlights the unusual presentation of osteoid osteoma with a multicentric nidus in a young female. Radiological workup with plain films, CT, and MRI was crucial for diagnosis. While RFA is gaining popularity, surgical excision remains a valid option, especially for atypical cases.

Intraoperative cone-beam computed tomography-guided curettage for osteoid osteoma

Recently, cone-beam computed tomography (CBCT)-guided surgeries have been developed for bone and soft tissue tumors. The present study aimed to evaluate the efficacy of CBCT-guided curettage for osteoid osteoma. Our study population included 13 patients who underwent primary curettage for osteoid osteoma using intraoperative CBCT in a hybrid operating room between April 2019 and November 2022. We collected the following data: sex, age, follow-up period, symptom onset to time of surgery, tumor size and location, length of skin incision, operating time, radiation dose, recurrence, postoperative complications, and visual analog scale for pain during the last follow-up. There were 10 male and 3 female patients, and the mean age was 25.0 years (range, 9-49 years). The mean follow-up period was 10.6 months (range, 0.4-24.0 months). The locations of the tumors were the proximal femur in 6 patients, the acetabular region in 2 patients, and the ilium, tibial shaft, calcaneus, cuboid, and talus in 1 patient each. The mean time of symptoms onset to surgery was 18.7 months (range, 2.3-69.9 months). The mean maximum diameter of the tumor was 5.9 mm (range, 3.5-10.0 mm). The mean length of the skin incision was 2.2 cm (range, 1.5-3.5 cm). The mean operating time was 96.9 minutes (range, 64-157 minutes). The mean dose of radiation was 193.2 mGy (range, 16.3-484.0 mGy). No recurrences, postoperative complications, and reoperation were observed in this study. All the patients reported 0 mm on the visual analogue scale for pain on the last follow-up. CBCT-guided curettage for osteoid osteoma was minimally invasive and reliable. This procedure can be effective for the treatment of lesions found in deep locations such as the pelvic bone and proximal femur or an invisible lesion that cannot be detected by regular fluoroscopy.

Avoiding Misdiagnosis and Missed Diagnosis for Appropriately Treating Spinal Osteoid Osteomas: A Single‐Center Experience

Objectives

To analyze the causes of misdiagnosis and missed diagnosis in spinal osteoid osteoma, and to put forward solutions to improve diagnosis accuracy and treatment efficacy in patients.

Methods

We performed a retrospective cohort study on patients with spinal osteoid osteoma in Beijing Jishuitan Hospital from January 1983 to September 2019. All patients underwent surgery. The outcome measures were the extent of local pain, nocturnal pain, radicular symptoms of extremities after surgery, and reduction or disappearance of lesions on CT after surgery.

Results

Thirty‐seven patients with spinal osteoid osteoma were recruited in the study. A total of 27% were female, and the mean (SD) age at diagnosis was 21.3 (8.7) years. A total of 87.0% of patients presented with nocturnal pain, and 94.7% of patients were responsive to NSAIDS treatment. The mean (SD) time from the initial onset of symptoms to the final diagnosis was 14.7 (12.5) months. Only four of 37 (10.8%) patients were correctly diagnosed with spinal osteoid osteoma on the first visit to the local hospital. CT is associated with a higher diagnosis rate than X‐ray or MRI on the first visit. Surgical navigation was used in 88.9% of patients who underwent curettage resection, and in 10% of patients who underwent en bloc resection. A total of 37 of 37 patients (100%) reported relief of local pain and radicular symptoms of extremities after surgery, and no recurrence of tumors was found during follow‐ups.

Conclusions

Spinal CTs are recommended to be performed if osteoid osteoma is suspected based on clinical manifestation, including nocturnal pain and responsiveness to NSAIDS treatment, to avoid misdiagnosis and missed diagnosis of spinal osteoid osteoma.

Computed tomography guided radiofrequency ablation of osteoid osteoma in children: a single center's experience

OBJECTIVE

To report a single center's experience evaluating the efficacy and safety of computed tomography-guided radiofrequency ablation for the treatment of osteoid osteoma in children.

MATERIALS AND METHODS

Institutional database research identified 33 symptomatic patients (≤ 18 years of age; male/female ratio: 21/12, mean age 13.09 ± 3.66) with osteoid osteoma who were treated by CT-guided RFA. Technical and clinical success as well as complication rates were recorded. The duration of the procedure, the number of computed tomography scans and the results of the biopsy were assessed. Pain, prior, the following morning and 1 week, 1/6/12 months after the procedure were compared by means of a numeric visual scale (NVS) questionnaire.

RESULTS

Mean lesion size was 8.28 ± 4.24 mm. Mean follow-up was 23.33 ± 17.61 months (range 12-62). Mean pain score prior to radiofrequency ablation was 9.06 ± 0.80 NVS units. On week 1 and 1/6/12 months, all patients were pain-free reporting 0 NVS units (p < 0.05). The mean procedure time was 54 min (range 51-59) and a mean of 7 CT scans were performed during the ablation session. RF electrode was successfully placed in the center of the nidus in all cases. In our study, none of our patient experienced recurrence of the pain, nor complications.

CONCLUSION

The present study demonstrates that percutaneous CT-guided radiofrequency ablation constitutes a safe and effective technique for osteoid osteoma treatment in children.

Comparison of arthroscopy versus percutaneous radiofrequency thermal ablation for the management of intra- and juxta-articular elbow osteoid osteoma: case series and a literature review

BACKGROUND

Today, intra-articular and juxta-articular osteoid osteomas are treated with arthroscopy and radiofrequency thermal ablation. However, for the case of an elbow joint, arguments are made for the use of a minimally invasive technique to be the optimal choice. This study aims to analyse our experiences of arthroscopically treated elbow osteoid osteomas and to compare it with the published results of both techniques.

METHODS

The retrospective study analyses the patients who underwent elbow arthroscopy ablation of an elbow osteoid osteoma at a single institution from January 2014 until March 2020. Clinical and diagnostic features, success and treatment failure rates, complications and tumour recurrence rates were all compared to 13 studies of intra-articular elbow osteoid osteoma arthroscopic ablation and 15 studies involving radiofrequency thermal ablation of intra-articular osteoid osteoma within different joints.

RESULTS

Four males and two females, with a mean age of 19.3 years, were encompassed. All the patients had immediate postoperative pain relief and improved range of motion. No tumour recurrences were observed during a median of 21.7 months. The literature review yielded 86.4% success rate, 68.2% successful biopsies, one minor complication and no recurrences following the arthroscopic ablation of an elbow osteoid osteoma; while radiofrequency thermal ablation of an intra-articular elbow osteoid osteoma yielded 96.3% success rate, 33.3% successful biopsies, no complications and 3.7% recurrence rate.

CONCLUSIONS

Our results are consistent with the published literature proving that arthroscopic ablation is an efficient method with low treatment failure rates and no recurrences in treating intra- and juxta-articular elbow osteoid osteomas. Advantages of arthroscopic ablation stem from the ability to visualise and safely deal with the lesion and the joint's reactive changes resulting in high biopsy rates, no recurrences and better postoperative elbow's range of motion. Still, the technique selection should be personalised considering the medical expertise of every institution.

Osteoid osteoma of the hip: imaging features

Osteoid osteoma (OO), a small bone tumor relatively common in young subjects, frequently involves the hip. In addition to typical findings, we emphasize unsuspected clinical and imaging features including painless OO causing limping gait, non-visibility of totally mineralized nidus, absence of hyperostosis or adjacent edema, and recurrence at distance from the initial location. We also discuss the option of medical treatment for some cases of deep hip locations.

Osteoid Osteoma in Children Younger than 3 Years of Age

We present a case series of four children, younger than 3 years old, with osteoid osteoma of the lower limb. Pain and limping were the main symptoms. With careful clinical examination, we could localize the affected area. Radiological evaluation revealed cortical thickening in 3 children. On MRI examination, we found extensive edema, with normal bony cortices. The central nidus was found in 3 children. CT scan was the most accurate examination which revealed the central nidus with surrounding sclerosis. Bone scans had positive uptake in the affected area. Our patients were treated with an intralesional excision biopsy, with simultaneous radiofrequency ablation in those affected in the femur. Pathological specimens confirmed the diagnosis of osteoid osteoma. There was uneventful recovery of our patients. This case series contributes to the limited description of osteoid osteoma diagnosed and treated in very young children.

Isolated primary bone tumours of the lesser trochanter: Demographics, diagnosis and management

Primary bone tumours arising from the lesser trochanter (LT) are rare and the literature describing them is sparse. In this paper, we describe the largest series of LT tumours describing the demographics, diagnosis and management.

METHODS

A retrospective search of prospectively maintained radiology and oncology databases was performed to identify bone tumours of the LT diagnosed between 2007 and 2018. Metastatic lesions were excluded. All cases were re-reviewed by a senior Radiologist and all case of isolated tumours of the LT were included.

RESULTS

23 cases of isolated LT tumours were identified. There were 15 males and 8 females. Mean age of our cohort was 32 (14-63) years. Most (n = 19, 82.6%) cases had classic radiological (Radiographic, MR Imaging and CT) features and therefore did not undergo biopsy. 4 patients had equivocal radiological investigations that required biopsy to confirm the diagnosis. MR imaging was the most commonly used imaging modality for diagnosis (n = 17, 73.9%)There was a broad range of tumour subtypes, and osteochondroma (n = 17, 73.9%) the most frequently diagnosed. Surgical excision was performed in 4 patients (all osteochondromas) and 4 patients underwent therapeutic radiological guided hip injections for symptomatic relief. The remaining cases were managed conservatively and where they were identified incidentally, no intervention was required.

CONCLUSION

We report the largest case series of isolated primary bone tumours of the LT. All isolated primary bone tumours of LT are benign. Osteochondroma is the most common. The diagnosis can be made with on radiological investigations in most patients.

Percutaneous excision of difficult osteoid osteomas using intraoperative AIRO CT navigation: a preliminary report

Osteoid osteomas are well known for intraoperative technical difficulties for localization and adequate excision, especially when they are not clearly visualized on plain radiographs or when they occur in difficult and inaccessible situations. Localization in the radiology suite and shifting the patient to the operating room can be cumbersome, and can result in errors because of lack of real-time imaging. In these scenarios, intraoperative navigation will be useful. We report a technique of intraoperative computed tomography (CT) navigation for localization and excision of osteoid osteomas of the long bones. Six patients (four femoral and two tibial lesions) with a radiological diagnosis of osteoid osteoma, in whom the nidus could not be visualized clearly on plain radiographs, were treated with this technique. Intraoperative CT navigation with AIRO was performed and the images were registered to the computer. The lesion was then localized and excised using a high-speed burr. All patients underwent postexcision on-table CT scans, which showed complete excision of the nidus. All patients became symptom free and are doing well at a minimum follow-up of 6 months. Intraoperative CT navigation helps to exactly localize the nidus and also helps to confirm complete excision of the nidus. This is a safe, effective and minimally invasive method to treat osteoid osteomas, particularly those that are not amenable to excision under C arm guidance.

Radiofrequency ablation of osteoid osteoma in atypical locations: a case series

BACKGROUND

Osteoid osteoma has a nidus surrounded by sclerotic bone with a size usually less than 20 mm. Its diagnosis is made on typical presentation of nocturnal pain and imaging findings. Excision of the niduses, which are often small and difficult to precisely identify, sometimes may result in resection of surrounding normal bone. Minimally invasive percutaneous treatments have been used to try to minimize resection of normal bone. Although minimally invasive radiofrequency ablation generally relieves pain, its ability to relieve pain is less well known in locations other than lower extremity long bones.

QUESTIONS/PURPOSES

We determined the pain relief and complication rates after radiofrequency ablation of osteoid osteomas presenting in atypical locations and followed patients to assess possible recurrence or late complications.

PATIENTS AND METHODS

We retrospectively reviewed 21 patients with osteoid osteomas in unusual locations (eg, hip, radioulnar joint, and proximal phalanx) in whom we used radiofrequency ablation. Postoperative activities were not restricted for any of the patients. We assessed the time for patients to become symptom free, their activity status, and possible recurrence or complications. The minimum clinical followup was 12 months (mean, 27.8 months; range, 12-37 months).

RESULTS

All patients became symptom free within 24 hours to 1 week. During followup, none of the patients experienced recurrence or any major complications.

CONCLUSIONS

Radiofrequency ablation for osteoid osteomas in unusual locations reliably relieves pain with few complications and recurrences at short-term followup.

LEVEL OF EVIDENCE

Level IV, case series. See Guidelines for Authors for a complete description of level of evidence.

Osteoid osteoma: diagnosis and treatment

Treatment of small but painful osteoid osteomas was traditionally based on either prolonged medication or resection. In the era of rapidly evolving minimally invasive techniques, reluctance has been posed against surgical interventions mostly due to their relatively high rates of recurrence, complications, or persistent pain. Nonetheless, incomplete pain control and intolerance to anti-inflammatory drugs unfavorably affect prognosis. The objective of this article is to explore the nature and clinical presentation of osteoid osteomas, discuss their imaging and histological features, review available data regarding surgical and percutaneous methods for addressing these lesions and comment on their feasibility, safety, and efficacy.

Image-guided laser ablation of osteoid osteoma in pediatric patients

BACKGROUND

We aimed to evaluate the effectiveness of image-guided laser ablation for the treatment of osteoid osteomas in pediatric patients.

METHODS

From June 1994 to June 2006, 68 patients aged 3 to 18 years (mean age, 12.1 +/- 4.2 years) with a diagnosis of osteoid osteoma underwent laser ablation in our department. Among them, 3 patients had prior unsuccessful attempt of surgical resection. Procedures were performed under spinal or general anesthesia with combined computed tomographic and fluoroscopic guidance. An 18-gauge needle was placed in the nidus after bone drilling when required, and an optical fiber was inserted through it. An average energy of 1200 J was delivered using an infrared diode laser generator. Patients were discharged the next day and followed up with assessment of pain, medication intakes, and potential complications. Clinical success was defined by complete pain relief without need for medication intake.

RESULTS

Technical success was achieved in all but 1 of our first patients, which was subsequently treated by percutaneous resection. Overall clinical success was 98%. Primary clinical success was obtained in 60 patients (88%). In 7 patients, recurrence of symptoms at 4 to 27 months from the initial procedure was managed by repeat laser ablation, resulting in secondary success (10%). No complications related to the procedure were observed. Follow-up ranged 16 to 146 months (mean, 83 months).

CONCLUSIONS

Currently, image-guided laser ablation is a safe and effective procedure that can be proposed as the mainstay treatment of osteoid osteomas in pediatrics.

LEVEL OF EVIDENCE

Therapeutic case series study level IV.

Arthroscopic removal of a subperiosteal osteoid osteoma of the talus

We report a case of a subperiosteal osteoid osteoma on the talar neck that was removed arthroscopically. Intralesional excision, en bloc resection, and percutaneous ablation techniques have all been used for the treatment of osteoid osteoma. For intra-articular osteoid osteomas, arthroscopy-assisted removal of the tumor has been described in a few case reports. Obtaining a nidus fragment for pathologic evaluation is important during arthroscopic removal of intra-articular osteoid osteomas. Sometimes it is not possible to obtain a specimen for pathologic examination. In the present case, the osteoid osteoma on the talar neck was easily located, the nidus was completely removed, and the tumor was extirpated.

Osteoid Osteoma: Experience with Laser- and Radiofrequency-Induced Ablation

The purpose of this study was to analyze the clinical outcome of osteoid osteoma treated by thermal ablation after drill opening. A total of 17 patients and 20 procedures were included. All patients had typical clinical features (age, pain) and a typical radiograph showing a nidus. In 5 cases, additional histological specimens were acquired. After drill opening of the osteoid osteoma nidus, 12 thermal ablations were induced by laser interstitial thermal therapy (LITT) (9F Power-Laser-Set; Somatex, Germany) and 8 ablations by radiofrequency ablation (RFA) (RITA; StarBurst, USA). Initial clinical success with pain relief has been achieved in all patients after the first ablation. Three patients had an osteoid osteoma recurrence after 3, 9, and 10 months and were successfully re-treated by thermal ablation. No major complication and one minor complication (sensible defect) were recorded. Thermal ablation is a safe and minimally invasive therapy option for osteoid osteoma. Although the groups are too small for a comparative analysis, we determined no difference between laser- and radiofrequency-induced ablation in clinical outcome after ablation.