Radiofrequency ablation of spinal osteoid osteoma: a prospective study

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>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.</jats:p></jats:sec>

Targeted Radiofrequency Ablation as an Adjunct in Treatment of Lumbar Facet Cysts

“…The approach to the cyst and the synovium with RF has not been addressed before this report. Recent studies have shown that RF current can safely be used intra-spinally, around the lumbar nerve roots, and within the contiguous vertebrae as long as the patient can undergo motor and sensory testing [6, 25]. In our longest clinical followup of three years, we confirmed with sequential MRI scans that there was a reduction and stabilization of a large dorsal cyst without re-accumulation or re-expansion.…”

A rare case of nasal osteoma in a dog: a case report

“…No chemotherapy after surgery is recommended. Radiofrequency ablation may be considered when complete surgical excision is not possible (Soltero-Rivera et al 2015;Faddoul et al 2016). Another treatment which is technically feasible in human medicine is image-guided cryoablation (Whitmore et al 2016).…”

Spinal osteoid osteoma: Surgical resection and review of literature

“…It mainly involves the lumbar spine with predilection for posterior elements seen in 75% of cases. [ 1 , 2 ] Pars interarticularis is the most common site of involvement. OOs are usually seen in patients under the age of 30 with a male preponderance (sex ratio – 2–4:1).…”