Multidisciplinary approach in the treatment of osteoid osteoma with radiofrequency ablation

Abstract

Osteoid osteoma (OO) is a benign tumor that is frequently seen in young people usually in the second and third decade. Tumor localization may be in cortical or cancellous bone. [1] Radiologically, a surrounding sclerotic lesion and a structure called "nidus" are present. Clinically, night pain is typical and frequently responds well to nonsteroidal drugs. There are many treatment modalities for OO including medical treatment, percutaneous radiofrequency ablation (RFA) treatment, and open surgical procedures. [1] However, despite all these different treatment methods, recurrence of OO is a significant problem. The protocol for a successful treatment should be planned in a different way for each patient. The multidisciplinary approach is an appropriate method for the treatment of various diseases that decreases the rate of morbidity in radiologic interventions as well as in many other fields of medicine. The synergy created by multiple disciplines Objectives: This study aims to present the importance of a multidisciplinary approach to radiofrequency ablation (RFA) treatment in osteoid osteoma (OO) patients by a team of experts in their field in preventing recurrence and complications. Patients and methods: For this retrospective study, a team of two orthopedists, two interventional radiologists, and one anesthesiologist was established in January 2013 to manage the diagnosis, follow-up, and treatment process of patients with OO at Bakırköy Dr. Sadi Konuk Training and Research Hospital. A total of 27 patients (15 males, 12 females; mean age 22.9 years; range, 9 to 54 years) were treated by this team between February 2013 and September 2016. The anatomic localization included iliac crest in four patients, the femur in 12 patients, fibula in two patients, humerus in three patients, radius in one patient, tibia in three patients, talus in one patient, and metacarpal in one patient. The procedures were carried out by the same interventional radiologists, same orthopedic surgeons, and same anesthesiologist in the computed tomography (CT) unit under aseptic conditions. After appropriate anesthesia for the localization of OO, the patient was positioned on the CT bed and the localization of the lesion was confirmed with a CT scan mapping. Then, a bone penetration cannula was advanced and bone cortex was penetrated with a charged motor and Kirschner (K)-wire. When the cannula reached the nidus, it was replaced with RFA probe. Ablation of the nidus was performed for five minutes at 90°C. Results: The mean follow-up period was 46 months (range, 25 to 66 months). Patients were evaluated with visual analog scale (VAS) scores preoperatively and at postoperative 15 th day, sixth month, and first year. In the last evaluation of the study data, the patients were called by telephone and questioned whether there were any changes in their final status. The mean preoperative VAS score was 7.2. The mean postoperative VAS scores of the 15 th day, sixth month, and first year were 1.3, 0.6, and 0, respectively. In the last follow-up, the OO...

Proximal femur osteoid osteoma in children: Diagnosis and management: A case series

“…Four intracapsular neck of femur lesions aged below 11 years were excluded from our study due to different diagnoses among the consultants requiring single or multiple biopsy and change of intervention as necessitated. Percutaneous CT guided radiofrequency ablation in cases of typical presentation, with clinical and imaging conclusive of diagnosis, yields better results and patient compliance 9,10 .…”

“…However, the location of the lesion in proximal femur (intra or extracapsular) and its atypical clinical presentation sometimes surprises with tissue diagnosis warranting a biopsy at preprocedural level to establish a working diagnosis 3-6 . However, management of osteoid osteoma by techniques like computed tomography (CT) guided percutaneous radiofrequency ablation or percutaneous bone drilling have yielded promising results [7][8][9][10] .…”

Osteoid osteoma: which is the best mininvasive treatment option?

“…Data reported in the literature have demonstrated that in case of symptomatic recurrence after the first RFA treatment, re-ablation is almost always resolutive with complete disappearance of symptoms, as suggested by the revision of the literature proposed [ 10 , 16 – 20 , 23 – 25 , 36 , 39 , 42 44 , 46 , 48 50 28 – 43 , 92 , 44 – 51 , 54 – 56 ] (Table 2 ).…”

Effectiveness and reliability of traditional open surgery in atypical localizations of osteoid osteoma

“…The most commonly used technique for the definitive treatment of OO lesions in recent years is percutaneous CT-guided radiofrequency ablation (RFA). [ 10 , 11 ] However, percutaneous treatment has some limitations. The process lasts for four to six min, the temperature rises up to 90 degrees during this time,[ 12 - 14 ] and hyperthermia in the surrounding tissues may occur.…”