Surgical treatment of chondroblastoma using extended intralesional curettage with phenol as a local adjuvant

Purpose: The aim of this study is to report the clinical and radiological outcomes following surgical treatment of chondroblastoma by means of an extended intralesional curettage using high-speed burr, with phenol as a local adjuvant which is followed by the implantation of synthetic bone graft, aiming to lower the recurrence rate of this tumor. Patients and Methods: This retrospective study included 20 patients with chondroblastoma lesions during the period between 2000 and 2015. Results: Fifteen males and five females were followed up for a mean of 63.35 (26–144) months with average age at the time of presentation was 20.8 (range: 12–32) years. Nineteen patients (95%) were complaining of pain at the time of presentation, and the lesion was discovered accidently in one patient. The mean operative time was 138.5 min (75–250). At the most recent follow-up, all patients had regained full physical function without pain at the operation site. Conclusion: The aggressive treatment of chondroblastoma by an extended intralesional curettage using high-speed burr with phenol as a local adjuvant seems effective in lowering the incidence of local recurrence and secondary more aggressive surgeries. Implantation of the bone defects that result from curettage with the synthetic bone substitutes is a good alternative due to rapid restoration of the mechanical strength with good remodeling.

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Extensive curettage using a high-speed burr versus dehydrated alcohol instillation for the treatment of enchondroma of the hand

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413517204 ◽

2013 ◽

Vol 40 (4) ◽

pp. 384-391 ◽

Cited By ~ 5

Author(s):

S. M. Cha ◽

H. D. Shin ◽

K. C. Kim ◽

I. Y. Park

Keyword(s):

Analogue Scale ◽

High Speed ◽

Proximal Phalanx ◽

Healing Time ◽

Complete Healing ◽

Pathological Fractures ◽

Active Motion ◽

The Mean ◽

High Speed Burr

The purpose of this retrospective study was to compare the clinical and radiological outcomes of patients treated with different adjuvant methods after curettage for enchondromas of the hand. Sixty-two patients with enchondroma were treated with high-speed burring (29 patients) or alcohol instillation (33 patients) after curettage. The mean follow-up was 40.8 months. No significant differences in the visual analogue scale, Disabilities of the Arm, Shoulder, and Hand scores, total range of active motion, grip strength, and complete healing time were observed between the groups. The distribution of the results of the formula by Wilhelm and Feldmeier were not significantly different between the groups. No surgery-related complications, postoperative pathological fractures, or recurrence was found in either group. For the treatment of enchondroma in the metacarpal and proximal phalanx, alcohol instillation immediately after curettage was as effective as extensive curettage using a high-speed burr.

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Is precise open excision a more suitable surgical method for osteoid osteoma?

10.21203/rs.3.rs-34229/v1 ◽

2020 ◽

Author(s):

Yuhao Yuan ◽

Feng Long ◽

Qing Liu ◽

Ziyi Wu ◽

Hongbo He ◽

...

Keyword(s):

Osteoid Osteoma ◽

High Speed ◽

Pathological Examination ◽

Vas Score ◽

Primary Surgery ◽

Second Surgery ◽

The Mean ◽

High Speed Burr ◽

Open Excision

Abstract Background The aim of this retrospective study was to evaluate the efficacy of precise open excision surgery to treat osteoid osteoma with C-arm assisted precise localization during the operation. Methods From June 2010 to June 2017, patients with osteoid osteoma of the extremities who had undergone treatment by high speed burr grinding, full scratching with curette, and C-arm assisted lesion localization during the operation were analyzed retrospectively. The preoperative and postoperative pain was assessed by the visual analogue scale (VAS) scoring. The patients were followed up regularly, and the advantages, effects, and complications of the therapeutic technique were analyzed. Results The study consisted of 94 patients (59 males, 35 females; mean age, 17.6 ± 8.5 years) and they were followed up for a mean of 38.9 months (range, 24–72 months). All patients were diagnosed with osteoid osteoma by postoperative pathological examination. Follow-up consisted of imaging reexamination and clinical evaluation. If the patients did not take non-steroidal anti-inflammatory drugs (NSAIDs) before the operation, the mean pre-operative VAS score was 6.7, and the mean VAS score of all patients was 0 one month after operation. The mean time for all patients to resume normal daily activities was 14.3 days (range, 10–21 days). There was no recurrence of pain, infection, vascular or nerve injury, and fracture complications during the follow-up. In only one case of distal femur osteoid osteoma (OO), review X-ray found a suspected recurrence 50 months after the primary surgery and subsequently, the patient underwent a second surgery. Till date, the patient has reported no discomfort following the second surgery. Conclusions For treatment of osteoid osteoma, open incision and minimal resection with C-arm assisted tumor localization is still a suitable method, especially for osteoid osteoma located on the surface of the cortical bone.

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Adjuvant Therapy by High-Speed Burr May Cause Intraoperative Bone Tumor Seeding: An Animal Study

10.21203/rs.3.rs-25950/v1 ◽

2020 ◽

Author(s):

Pai-han Wang ◽

Chia-Lun Wu ◽

Chao-Ming Chen ◽

Jir‐You Wang ◽

Po-Kuei Wu ◽

...

Keyword(s):

Adjuvant Therapy ◽

High Speed ◽

Residual Tumor ◽

Femoral Bone ◽

Intralesional Curettage ◽

Tumor Spread ◽

Tumor Seeding ◽

High Speed Burr ◽

Cadaver Femur ◽

Tumor Cell Killing

Abstract BackgroundBone tumors are often treated with intralesional curettage. High-speed burring, an adjuvant therapy, was performed to maximize the tumor cell killing; however, tumor recurrence might still occur, which may be caused by residual tumor or local tumor spread during surgery.MethodsA porcine cadaver (femur) was utilized to determine whether the use of a high-speed burr causes bone cement spray. To mimic residual tumor after curettage, luminescent cement was smeared on two locations of the bone cavity, the wall and the bottom. The cavity in the femoral bone was then placed in the middle of a sheet of drawing paper featuring 10 cm, 20 cm, and 30 cm concentric circles. The luminescent cement was then burred totally with a high-speed burr.ResultsThe intensity of the area in the wall in circle I was 72.6% ± 5.8%; within circle II, it was 22.1% ± 4.2%; and within circle III, it was 5.4% ± 1.5%. The intensity of the area within the bottom of the femoral bone within circle I was 66.5% ± 6.1%, within circle II was 28.1 ± 4.8%, and within circle III, it was 5.4% ± 1.4%. The amount of luminescent cement seeding decreased with distance, but there was no difference while burring at different locations of the bone cavity. Under the handpiece cover, a greater amount of cement spray was retained in circle I during burring of the cement in the bottom of the cavity and less was sprayed out in circle III.ConclusionsHigh-speed burring may cause tumor seeding, which could extend to 20 cm. The intensities of spray did not decrease, even when the handpiece cover was used. The correlation between high-speed burring and tumor seeding was highly suspect in this pilot study.

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Preponderance of precise open excision surgery to treat osteoid osteoma

10.21203/rs.3.rs-17547/v1 ◽

2020 ◽

Author(s):

Yuhao Yuan ◽

Feng Long ◽

Qing Liu ◽

Ziyi Wu ◽

Hongbo He ◽

...

Keyword(s):

Osteoid Osteoma ◽

High Speed ◽

Pathological Examination ◽

Vas Score ◽

Primary Surgery ◽

Second Surgery ◽

The Mean ◽

High Speed Burr ◽

Open Excision

Abstract PurposeThe aim of this retrospective study was to evaluate the efficacy of precise open excision surgery to treat osteoid osteoma with C-arm assisted precise localization during the operation.MethodsFrom June 2010 to June 2017, patients with osteoid osteoma of the extremities who had undergone treatment by high speed burr grinding, full scratching with curette, and C-arm assisted lesion localization during the operation were analyzed retrospectively. The preoperative and postoperative pain was assessed by the visual analogue scale (VAS) scoring. The patients were followed up regularly, and the advantages, effects, and complications of the therapeutic technique were analyzed.ResultsThe study consisted of 94 patients (59 males, 35 females; mean age, 17.6 ± 8.5 years) and they were followed up for a mean of 38.9 months (range, 24–72 months). All patients were diagnosed with osteoid osteoma by postoperative pathological examination. Follow-up consisted of imaging reexamination and clinical evaluation. If the patients did not take non-steroidal anti-inflammatory drugs (NSAIDs) before the operation, the mean pre-operative VAS score was 6.7, and the mean VAS score of all patients was 0 one month after operation. The mean time for all patients to resume normal daily activities was 14.3 days (range, 10-21 days). There was no recurrence of pain, infection, vascular or nerve injury, and fracture complications during the follow-up. In only one case of distal femur osteoid osteoma (OO), review X-ray found a suspected recurrence 50 months after the primary surgery and subsequently, the patient underwent a second surgery. Till date, the patient has reported no discomfort following the second surgery.ConclusionsFor treatment of osteoid osteoma, open incision and minimal resection with C-arm assisted tumor localization is still a suitable method, especially for osteoid osteoma located on the surface of the cortical bone.

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Giant Cell Tumor of the Capitate Bone

Journal of Hand and Microsurgery ◽

10.1055/s-0038-1631876 ◽

2018 ◽

Vol 10 (03) ◽

pp. 158-161 ◽

Cited By ~ 4

Author(s):

Ahmadreza Afshar ◽

Ali Tabrizi ◽

Ali Aidenlou ◽

Ata Abbasi

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

High Speed ◽

Cell Tumor ◽

Intralesional Curettage ◽

Allogenic Bone ◽

High Speed Burr ◽

The Right ◽

Allogenic Bone Graft ◽

Capitate Bone

AbstractThis case report describes a 16-year-old female patient with a giant cell tumor in her right capitate bone. The tumor was removed by intralesional curettage. A high-speed burr was used to extend the margins of the curettage, and alcohol irrigation was used for adjuvant therapy. The cavity of the capitate was filled with allogenic bone graft. There was no recurrence after 2 years of follow-up, and the right wrist radiographs demonstrated healing of the lesion.

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Efficacy of precise open excision surgery in treatment of osteoid osteoma

10.21203/rs.3.rs-19232/v1 ◽

2020 ◽

Author(s):

Yuhao Yuan ◽

Feng Long ◽

Qing Liu ◽

Ziyi Wu ◽

Hongbo He ◽

...

Keyword(s):

Osteoid Osteoma ◽

High Speed ◽

Pathological Examination ◽

Vas Score ◽

Primary Surgery ◽

The Mean ◽

High Speed Burr ◽

Suspected Recurrence ◽

Open Excision

Abstract Purpose The aim of this retrospective study was to evaluate the efficacy of precise open excision surgery to treat osteoid osteoma with C-arm assisted precise localization during the operation.Methods From June 2010 to June 2017, patients with osteoid osteoma of the extremities who had undergone treatment by high speed burr grinding, full scratching with curette, and C-arm assisted lesion localization during the operation were analyzed retrospectively. The preoperative and postoperative pain was assessed by the visual analogue scale (VAS) scoring. The patients were followed up regularly, and the advantages, effects, and complications of the therapeutic technique were analyzed.Results The study consisted of 94 patients (59 males, 35 females; mean age, 17.6 ± 8.5 years) and they were followed up for a mean of 38.9 months (range, 24–72 months). All patients were diagnosed with osteoid osteoma by postoperative pathological examination. Follow-up consisted of imaging reexamination and clinical evaluation. If the patients did not take non-steroidal anti-inflammatory drugs (NSAIDs) before the operation, the mean pre-operative VAS score was 6.7, and the mean VAS score of all patients was 0 one month after operation. The mean time for all patients to resume normal daily activities was 14.3 days (range, 10-21 days). There was no recurrence of pain, infection, vascular or nerve injury, and fracture complications during the follow-up. In only one case of distal femur osteoid osteoma (OO), review X-ray found a suspected recurrence 50 months after the primary surgery and subsequently, the patient underwent a second surgery. Till date, the patient has reported no discomfort following the second surgery.Conclusions For treatment of osteoid osteoma, open incision and minimal resection with C-arm assisted tumor localization is still a suitable method, especially for osteoid osteoma located on the surface of the cortical bone.

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Revision for Cage Migration After Transforaminal/Posterior Lumbar Interbody Fusion; How to Perform Revision Surgery?

10.21203/rs.3.rs-1091472/v1 ◽

2021 ◽

Author(s):

Masato Tanaka ◽

Zhang Wei ◽

Akihiro Kanamaru ◽

Shin Masuda ◽

Koji Uotani ◽

...

Keyword(s):

Revision Surgery ◽

High Speed ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

High Speed Burr ◽

Radicular Symptoms ◽

Cage Migration ◽

Type 3

Abstract BackgroundSymptomatic pseudarthrosis and cage migration/protrusion are difficult complications of transforaminal or posterior lumbar interbody fusion (TLIF/PLIF). If the patient experiences severe radicular symptoms due to cage protrusion, removal of the migrated cage is necessary. However, this procedure is sometimes very challenging because epidural adhesions and fibrous union can be present between the cage and vertebrae. We describe a novel classification and technique utilizing a navigated osteotome and the oblique lumbar interbody fusion at L5/S1 (OLIF51) technique to address this problem.MethodsThis retrospective study investigated consecutive patients with degenerative lumbar diseases who underwent TLIF/PLIF. Symptomatic cage migration was evaluated by direct examination, radiography, and/or computed tomography (CT) at 1, 3, 6, 12, and 24 months of follow-up. Cage migration/protrusion was defined as symptomatic cage protrusion >5 mm from the posterior border of the over and underlying vertebral body compared with initial CT. We evaluated patient characteristics including body mass index, smoking history, fusion level, and cage type. A total of 113 patients underwent PLIF/TLIF (PLIF n=30, TLIF n=83), with a mean age of 71.1 years (range, 28–87 years). Mean duration of follow-up was 25 months (range, 12-47 months). ResultsCage migration was identified in 5 of 113 patients (4.4%). All cases of symptomatic cage migration involved the L5/S1 level and the TLIF procedure. Risk factors for cage protrusion were age (younger), sex (male), and level (L5/S1). The mean duration to onset of cage protrusion was 3.2 months (range, 2–6 months). We applied a new classification for cage protrusion: type 1, only low back pain without new radicular symptoms; type 2, low back pain with minor radicular symptoms; or type 3, cauda equina syndrome and/or severe radicular symptoms. According to our classification, one patient was in type 1, three patients were in type 2, and one patient was in type 3. For all cases of cage migration, revision surgery was performed using a navigated high-speed burr and osteotome, and the patient in group 1 underwent additional PLIF without removal of the protruding cage. Three revision surgeries (group 2) involved removal of the protruding cage and PLIF, and one revision surgery (group 3) involved anterior removal of the cage and OLIF51 fusion.ConclusionsThe navigated high-speed burr, navigated osteotome, and OLIF51 technique appear very useful for removing a cage with fibrous union from the disc in patients with pseudarthrosis. This new technique makes revision surgery after cage migration much safer, and more effective. This technique also reduces the need for fluoroscopy.

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Adjuvant Therapy by High-Speed Burr May Cause Intraoperative Bone Tumor Seeding: an animal study

10.21203/rs.3.rs-25950/v2 ◽

2020 ◽

Author(s):

Pai-han Wang ◽

Chia-Lun Wu ◽

Chao-Ming Chen ◽

Jir‐You Wang ◽

Po-Kuei Wu ◽

...

Keyword(s):

Adjuvant Therapy ◽

Bone Cement ◽

High Speed ◽

Residual Tumor ◽

Femoral Bone ◽

Intralesional Curettage ◽

Tumor Spread ◽

Tumor Seeding ◽

Wide Range ◽

High Speed Burr

Abstract Background Bone tumors are often treated with intralesional curettage. High-speed burring, an adjuvant therapy, was performed to maximize the tumor cell killing; however, tumor recurrence might still occur, which may be caused by residual tumor or local tumor spread during surgery. Methods A porcine cadaver (femur) was utilized to determine whether the use of a high-speed burr causes bone cement spray. To mimic residual tumor after curettage, luminescent cement was smeared on two locations of the bone cavity, the wall and the bottom. The cavity in the femoral bone was then placed in the middle of a sheet of drawing paper featuring 10 cm, 20 cm, and 30 cm concentric circles. The luminescent cement was then burred totally with a high-speed burr. Results The intensity of the area in the wall in circle I was 72.6% ± 5.8%; within circle II, it was 22.1% ± 4.2%; and within circle III, it was 5.4% ± 1.5%. The intensity of the area within the bottom of the femoral bone within circle I was 66.5% ± 6.1%, within circle II was 28.1 ± 4.8%, and within circle III, it was 5.4% ± 1.4%. The amount of luminescent cement seeding decreased with distance, but there was no difference while burring at different locations of the bone cavity. Under the handpiece cover, a greater amount of cement spray was retained in circle I during burring of the cement in the bottom of the cavity and less was sprayed out in circle III. Conclusions High-speed burring may cause explosive bone cement spray, which could extend to 20 cm. The intensities of spray did not decrease, even when the handpiece cover was used. The wide range of bone cement spray caused by high-speed burr was inspected in this pilot study, which may lead to tumor seeding.

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Low-Grade Chondrosarcomas: Diagnosis and Treatment

10.21203/rs.3.rs-688425/v1 ◽

2021 ◽

Author(s):

Ozgur Erdogan ◽

serdar demiröz ◽

emre kaya ◽

güray altun ◽

volkan gürkan

Keyword(s):

High Speed ◽

Tumor Location ◽

Low Grade ◽

Recurrence Rates ◽

Intralesional Curettage ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Multiple Parameters ◽

Treatment Type ◽

High Speed Burr

Abstract Background: Multiple parameters are needed to distinguish between enchondroma and low-grade chondrosarcoma (LGCS). This study aimed to investigate the diagnosis, surgery type according to bone type, recurrence rates, and complications of LGCS in the appendicular and axial skeletons. Methods: A total of 52 surgically treated patients with LGCS, between March 2007 and May 2019, were retrospectively examined. Following diagnosis, the patients were operated on with intralesional curettage for long bones or wide local excision (WLE) for axial bones. The retrieved data included demographics, tumor location, surgical treatment type, local adjuvants, complications, and Musculoskeletal Tumor Society scores.Results: The final cohort included 52 patients (52 tumors; 35 female and 17 male). The male:female ratio was 1:2. The mean age was 44 ± 17 years. Forty of the tumors were treated with intralesional procedures (all with a high-speed burr and phenol), 6 with autograft, 8 with allograft, and 28 with cement augmentation, while 7 were treated with WLE.Conclusions: The use of phenol as an adjuvant may reduce recurrence rates. Using a putty graft alone may result in nonunion. Applying a thin layer of putty on the cementum can create callus tissue on the cementum. Even in the upper limb, plate and screw fixation should be used to prevent fractures in metaphyseal–diaphyseal curettages.

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