Percutaneous Radiofrequency Ablation of Osteoid Osteoma

Background: Osteoid osteoma is benign bone tumor that accounts for approximately 11% of all benign bone tumors. Pain is the hallmark of its clinical presentation, and is dramatically relieved by aspirin or non-steroidal anti-inflammatory drugs. Complete surgical resection has historically been the treatment of choice. Enbloc excision often requires a long incision, extensive dissection and, frequently, internal fixation. Minimally invasive therapies, such as percutaneous radiofrequency (RF) ablation, have recently been developed. The use of RF ablation to treat osteoid osteoma was described to be safe, effective and avoids drawbacks of surgery. Purpose: To report our experience in treating osteoid osteoma in different sites by RF ablation regarding the technical and clinical success, safety, complications, short and long-term follow-up. Patients and Methods: Between November 2006 and June 2012, 120 patients underwent CT-guided percutaneous RF ablations for osteoid osteoma. Most of the lesions were located in the long bones, most commonly in the femur (n=74), followed by the tibia (n=31), humerus (n=6), 3 cases were in iliac bone, 3 in the lumbar vertebrae and 1 in the scapular glenoid, 1 in the acetabulum and 1 in the cervical spine. The patients did the procedures under spinal or general anesthesia using a 9mm exposed-tip probe radiofrequency probe Soloist Single Needle Electrode. Patients were followed-up at lweek, lmonth, and every 3 months thereafter in the first year and another visit after 2 years. Results: The technical success rate was 100%. Within the follow-up period (6-24 month) 13 patient (10.8%) missed the follow-up visits; with the overall clinical success in the rest of the patients (89.2%) whom showed no pain recurrence. All patients had initial prompt pain relief and were able to return to their normal activities and discontinued analgesics. Two patients (1.6%) had recurrence of pain after 6 months and underwent repeat radiofrequency ablation. Two patients (1.6%) with a tibial shaft lesions developed superficial skin burn (epidermolysis), which responded well to conservative treatment. Conclusion: We believe that percutaneous RFA is a safe and effective treatment for osteoid osteoma with significant advantages over surgery. It has a high clinical success rate and low incidence of complication.