Radiofrequency ablation of spinal osteoid osteoma: a prospective study

OBJECTIVE Surgery has been considered the standard treatment for spinal osteoid osteomas that are refractory to analgesic agents. Radiofrequency ablation (RFA) is a less invasive technique with established efficiency for the treatment of peripheral osteoid osteomas. The main objectives of this study are to evaluate the safety of RFA based on the results of a previous experimental study in rats conducted in the authors' laboratory and to identify its short- and long-term efficiency in the treatment of spinal osteoid osteomas. METHODS Between March 2009 and July 2016, 8 consecutive patients with spinal osteoid osteomas were enrolled in the study and underwent 9 CT-guided RFA procedures. All patients presented with spinal pain (median preoperative visual analog scale [VAS] score 7.55, range 6–8.8) predominantly during the night, and they all had normal neurological examination results before the procedure. Pain (according to the VAS score) and neurological status were reassessed immediately before discharge, with further follow-up at 1, 6, and 12 months after the procedure. At the final follow-up, VAS score, neurological examination, patient satisfaction, and a radiological control (CT scan) were documented (median 48 months, range 12–84 months). VAS scores before and after the procedure were compared during the 3 days before surgery (D0), on the day of the surgery, Day 1 (D1), and at the final follow-up. RESULTS No neurological deficit was documented following the procedure or at the final follow-up. A statistically significant reduction in the VAS score was observed on Day 1 (mean 2.56 ± 0.68, p = 0.005) compared with D0. At the final follow-up, all patients reported a VAS score of 0 and a satisfaction rate of 100%. Only 1 patient had recurrent symptoms (pain, VAS score 8.1) 6 months after the initial RFA. A second procedure was performed, and the patient was subsequently symptom free at the final follow-up. CT scanning performed in all patients (12–84 months post-RFA) showed residual sclerosis in 4 patients and complete resolution of the radiological lesion in the remaining 4 patients. CONCLUSIONS CT-guided RFA appears to be a safe and effective method for the management of spinal osteoid osteoma and can be safely performed for lesions close to the dura or exiting nerve root based on the motor response threshold testing performed during the procedure. It should be considered the treatment of choice for spinal osteoid osteomas refractory to conservative treatment, thus avoiding more aggressive spinal approaches with subsequent potential morbidity.

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CT-Guided Percutaneous Radiofrequency Ablation in Osteoid Osteoma: Re-Assessments of Results with Optimized Technique and Possible Pain Patterns in Mid-Term Follow-Up

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren ◽

10.1055/s-0031-1299121 ◽

2012 ◽

Vol 184 (04) ◽

pp. 333-339 ◽

Cited By ~ 6

Author(s):

G. Omlor ◽

C. Merle ◽

B. Lehner ◽

V. Ewerbeck ◽

C. Rehnitz ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Osteoid Osteoma ◽

Percutaneous Radiofrequency Ablation ◽

Ct Guided

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Osteoid Osteoma: CT-guided Percutaneous Radiofrequency Ablation and Follow-up in 47 Patients

Journal of Vascular and Interventional Radiology ◽

10.1016/s1051-0443(07)61443-2 ◽

2001 ◽

Vol 12 (6) ◽

pp. 717-722 ◽

Cited By ~ 201

Author(s):

Klaus Woertler ◽

Thomas Vestring ◽

Friedrich Boettner ◽

Winfried Winkelmann ◽

Walter Heindel ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Osteoid Osteoma ◽

Percutaneous Radiofrequency Ablation ◽

Ct Guided

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CT-guided radiofrequency ablation of osteoid osteoma and osteoblastoma: Clinical success and long-term follow up in 77 patients

European Journal of Radiology ◽

10.1016/j.ejrad.2012.04.037 ◽

2012 ◽

Vol 81 (11) ◽

pp. 3426-3434 ◽

Cited By ~ 70

Author(s):

Christoph Rehnitz ◽

Simon David Sprengel ◽

Burkhard Lehner ◽

Karl Ludwig ◽

Georg Omlor ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Osteoid Osteoma ◽

Clinical Success ◽

Ct Guided ◽

Long Term Follow Up

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Comparison of Pulsed Radiofrequency, Oxygen-Ozone Therapy and Epidural Steroid Injections for the Treatment of Chronic Unilateral Radicular Syndrome

Medicina ◽

10.3390/medicina57020136 ◽

2021 ◽

Vol 57 (2) ◽

pp. 136

Author(s):

Pavel Ryska ◽

Jiri Jandura ◽

Petr Hoffmann ◽

Petr Dvorak ◽

Blanka Klimova ◽

...

Keyword(s):

Pain Relief ◽

Analogue Scale ◽

Pulsed Radiofrequency ◽

Ozone Therapy ◽

Ct Guided ◽

The Third ◽

Vas Score ◽

Radicular Syndrome ◽

Epidural Steroid

Background and objectives: For the treatment of chronic unilateral radicular syndrome, there are various methods including three minimally invasive computed tomography (CT)-guided methods, namely, pulsed radiofrequency (PRF), transforaminal oxygen ozone therapy (TFOOT), and transforaminal epidural steroid injection (TFESI). Despite this, it is still unclear which of these methods is the best in terms of pain reduction and disability improvement. Therefore, the purpose of this study was to evaluate the short and long-term effectiveness of these methods by measuring pain relief using the visual analogue scale (VAS) and improvement in disability (per the Oswestry disability index (ODI)) in patients with chronic unilateral radicular syndrome at L5 or S1 that do not respond to conservative treatment. Materials and Methods: After screening 692 patients, we enrolled 178 subjects, each of whom underwent one of the above CT-guided procedures. The PRF settings were as follows: pulse width = 20 ms, f = 2 Hz, U = 45 V, Z ˂ 500 Ω, and interval = 2 × 120 s. For TFOOT, an injection of 4–5 mL of an O2-O3 mixture (24 μg/mL) was administered. For the TFESI, 1 mL of a corticosteroid (betamethasone dipropionate), 3 mL of an anaesthetic (bupivacaine hydrochloride), and a 0.5 mL mixture of a non-ionic contrast agent (Iomeron 300) were administered. Pain intensity was assessed with a questionnaire. Results: The data from 178 patients (PRF, n = 57; TFOOT, n = 69; TFESI, n = 52) who submitted correctly completed questionnaires in the third month of the follow-up period were used for statistical analysis. The median pre-treatment visual analogue scale (VAS) score in all groups was six points. Immediately after treatment, the largest decrease in the median VAS score was observed in the TFESI group, with a score of 3.5 points (a decrease of 41.7%). In the PRF and TFOOT groups, the median VAS score decreased to 4 and 5 points (decreases of 33% and 16.7%, respectively). The difference in the early (immediately after) post-treatment VAS score between the TFESI and TFOOT groups was statistically significant (p = 0.0152). At the third and sixth months after treatment, the median VAS score was five points in all groups, without a statistically significant difference (p > 0.05). Additionally, there were no significant differences in the Oswestry disability index (ODI) values among the groups at any of the follow-up visits. Finally, there were no significant effects of age or body mass index (BMI) on both treatment outcomes (maximum absolute value of Spearman’s rank correlation coefficient = 0.193). Conclusions: Although the three methods are equally efficient in reducing pain over the entire follow-up, we observed that TFESI (a corticosteroid with a local anaesthetic) proved to be the most effective method for early post-treatment pain relief.

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What makes CT guided radiofrequency ablation for osteoid osteoma superior to open surgery in terms of pain control and patient’s quality of life?

The Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1016/j.ejrnm.2015.05.015 ◽

2015 ◽

Vol 46 (4) ◽

pp. 949-955 ◽

Cited By ~ 2

Author(s):

Mostafa Mohamed Mostafa Elian ◽

Ahmed Fathy Sadek

Keyword(s):

Quality Of Life ◽

Radiofrequency Ablation ◽

Osteoid Osteoma ◽

Pain Control ◽

Open Surgery ◽

Ct Guided

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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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Complications of Computer Tomography Assisted Radiofrequency Ablation in the Treatment of Osteoid Osteoma

BioMed Research International ◽

10.1155/2019/4376851 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Yunus Oc ◽

Bekir Eray Kilinc ◽

Sahin Cennet ◽

Mehmet Metin Boyacioglu ◽

Rodi Ertugrul ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Osteoid Osteoma ◽

Bone Tumors ◽

Skin Infection ◽

Primary Bone Tumors ◽

Benign Bone Tumors ◽

Superficial Skin ◽

Primary Bone ◽

A Prospective Study

Background. Osteoid osteoma (OO) is one of the most commonly occurring benign bone tumors. It constitutes 10-12% of benign bone tumors and 2-3% of primary bone tumors. In radiofrequency ablation (RFA) treatment, the cells of the tumor are thermally inactivated by the help of electrodes shaped like needles. In our study, we aimed to show the major and minor complications in patients undergoing RFA and to show what should be done to prevent these complications. Methods. The study was carried out as a prospective study on the follow-up of 87 osteoid osteoma patients treated between 2015 and 2017. The youngest of the patients was 1 year old and the oldest was 42 years old. The RFA procedure lasted 10 min on average, excluding anesthesia and preparation. All lesions were ablated at 90 degrees for 7 minutes with the heat increased gradually. All patients were followed up for 1 day in the orthopedics clinic. Results. Complications were observed in 7 patients. The lesions with the most complications were observed to be in the tibia, second-degree burns were seen in 2 patients, and superficial skin infection was observed in 2 patients. In 1 patient, the probe tip was broken and remained within the bone. Intramuscular hematoma was detected in 1 lesion located in the proximal femur. A complaint of numbness in the fingers developed in a lesion located in the metacarpus. Conclusion. Preventive measures should be taken before the procedure in order to prevent minor complications, and, for major complications, close follow-up should be done after the procedure and patients should be kept away from heavy physical activities for the first 3 months.

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