Osteoid osteoma: which is the best mininvasive treatment option?

Abstract

Osteoid osteoma is the third most common benign bone tumor, with well-known clinical presentation and radiological features. Although surgical excision has been the only therapeutic option for a long time, to date it has been replaced by minimally invasive techniques, which proved satisfactory success rates and low complication occurrence. Therefore, the purpose of this literature review was to describe the main updates of these recent procedures in the field of interventional radiology, with particular attention paid to the results of the leading studies relating to the efficacy, complications, and recurrence rate. Nevertheless, this study aimed to analyze the peculiarities of each reported technique, with specific focus on the possible improvements and pitfalls. Results proved that all mininvasive procedures boast a high success rate with slight number of complications and a low recurrence rate. Radiofrequency ablation is still considered the gold standard procedure for percutaneous treatment of osteoid osteoma, and it has the possibility to combine treatment with a biopsy. Interstitial laser ablation’s advantages are the simplicity of use and a lower cost of the electrodes, while cryoablation allows real-time visualization of the ablated zone, increasing the treatment safety. Magnetic resonance-guided focused ultrasound surgery is the most innovative non-invasive procedure, with the unquestionable advantage to be radiation free.

Interventional Radiology’s Osteoid Osteoma Management: Percutaneous Thermal Ablation

“…During the last 30 years, RFA has progressively replaced the surgical treatment and, due to its safety and effectiveness [7][8][9][10][11][12], became the gold standard for the treatment of osteoid osteoma (OO).…”

“…Most patients undergo conscious sedation and spinal anesthesia; less frequently, general anesthesia is needed. Pain control is usually not obtained with local anesthesia alone [3,7].…”

“…The authors retrospectively analyzed 36 studies, 32 of which (88.9%) evaluated RFA; 3 (8.3%) analyzed cryoablation (CA), and 1 (2.8%) microwave (MW) ablation. For each study, they assessed clinical success, failures, recurrences, and success rates [4,7].…”

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

“…Most osteoid osteomas occur between the ages of 20 to 30 years, with a male to female ratio of 2:1‐3:1 2 . About 10% of osteoid osteoma occurs in the spine 3 , mostly involving the posterior elements of the spine 4 . Osteoid osteoma is pathologically characterized by a nidus of un‐mineralized immature osteoid tissue surrounded by varying degrees of reactive sclerotic bone 5 .…”

“…The traditional surgical approaches for spinal osteoid osteoma include curettage and en bloc excision 9 , 10 . Recently, minimally invasive interventions including CT‐guided excision and radio‐frequency ablation have also been encouraged 3 , 11 , 12 . However, there have limited studies on systemically analyzing the factors contributing to misdiagnosis and missed diagnosis of spinal osteoid osteoma or presenting strategies to eliminate misdiagnosis and missed diagnosis of the disease.…”