Radiofrequency ablation for treatment for osteoid osteoma of the scapula using a new three-dimensional fluoroscopic navigation system

Abstract

Osteoid osteoma is a relatively common benign skeletal tumor. The traditional standard treatment has been surgical resection of the nidus. Recently, computed tomography (CT)-guided radiofrequency ablation (RFA) has gained favor as a more precise alternative due to potentially less bone destruction. However, CT-guided RFA is limited in treatment for osteoid osteoma involving complex anatomic structures such as cervical spine, pelvis, or scapula because of difficulty in approach and proximity to neurovascular structures. To solve this problem, we investigated RFA using a new real-time three-dimensional fluoroscopic navigation system. We report its technical procedure and use in a rare case of osteoid osteoma of the scapula.

Evaluation of accuracy and precision of CT-guidance in Radiofrequency Ablation for osteoid osteoma in 86 patients

“…Not many studies have been published in this field [4]. An experimental study on 5 patients using (live guidance) fluoroscopy overlaying on CT data achieved a median accuracy of 0.6 mm [7]. …”

“…The main advantage of RFA compared to other forms of treatment is the minimal invasive character of the therapy in combination with the corresponding low complication rate [6]. As a result of the minimal invasive character the hospitalization- and rehabilitation periods are relatively short [7]. …”

Mini-open excision of osteoid osteoma using intraoperative O-arm/Stealth navigation

“…Osteoid osteomas are small, benign osteoblastic bone tumors that commonly occur in the diaphysis of long bones in children and young adults [1,2]. It accounts for approximately 12% of all benign bone tumors and typically presents with extensive pain, which often worsens at night and is usually relieved by non-steroidal antiinflammatory drugs (NSAIDs) [2,3]. Osteoid osteomas have a nidus of several millimeters surrounded by dense sclerotic bone [1,3].…”

“…It accounts for approximately 12% of all benign bone tumors and typically presents with extensive pain, which often worsens at night and is usually relieved by non-steroidal antiinflammatory drugs (NSAIDs) [2,3]. Osteoid osteomas have a nidus of several millimeters surrounded by dense sclerotic bone [1,3]. Traditionally, osteoid osteomas have been treated by surgical excision for the management of pain that is resistant to NSAIDs, which is the first line of treatment [4,5].…”

“…Traditionally, osteoid osteomas have been treated by surgical excision for the management of pain that is resistant to NSAIDs, which is the first line of treatment [4,5]. While success rate by surgical excision is high (90%e100%) [6e12], recent introduction of radiofrequency ablation (RFA) has provided less invasive treatment [3,7,13,14] with relatively high success rate [7,9,12,15e19]. Regardless of treatment type, accurate localization of the nidus is crucial during procedures [4].…”