Abstract
Twenty-one consecutive patients with osteoid osteoma treated with computed tomography-guided radiofrequency ablation, after failed conservative treatment, were retrospectively reviewed. The diagnosis was based on typical clinical and imaging features. Radiofrequency ablation of osteoid osteomas was undertaken by heating the tip of the electrode to 90°C for three sessions of 2 min each. Follow-up evaluation included clinical examination and questionnaire, and radiographic evaluation was conducted on the first month, 12th month, and at the latest examination. Within the first 24 h post-procedure, pain was improved in all patients. Seven patients had pain relief within the first 3 days, 11 patients within the first week, and 3 patients within 2 weeks post-procedure. A month after the procedure, no patient had difficulty regarding self-care and daily activities. At a mean follow-up of 29 months (range 12–60 months), early or late complications and signs of local recurrence were not observed.
Résumé
Vingt et un patients consécutifs porteurs d’ostéome ostéoïde ont été traités par radiofréquence sous contrôle tomodensitométrique. La diagnostic a été porté sur les signes cliniques et radiologiques pathognomoniques. L’intervention était pratiquée en chauffant l’électrode à 90° C pour trois séances de 2 minutes chacune. Le suivi consistait en un examen clinique accompagnée d’un questionnaire à compléter et en un contrôle radiologique réalisé le premier mois, le 12ème mois, et lors du dernier examen. Tous les patients voyaient leur douleur améliorée au cours des 24 premières heures. Une disparition totale de la douleur a été observée chez 7 patients dans les premiers 3 jours, chez 11 patients dans la première semaine, et chez 3 patients deux semaines après l’opération. Tous les patients ont recouvré une activité normale au bout d’un mois. Pour une durée moyenne de suivi de 29 mois (12–60 mois), au dernier recul, aucune récidive n’a été observée.
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Appendices
Appendix 1
Data of the patients included in this study
Patient | Age | Sex | Location | Duration of symptoms (months) | Anaesthesia | Duration of the procedure (min) | Duration of stay in hospital (h) | Follow-up (months) | Complications |
|---|---|---|---|---|---|---|---|---|---|
1 | 23 | M | Femoral neck | 14 | Spinal | 50 | 6 | 60 | 0 |
2 | 26 | M | Femoral head | 14 | Spinal | 70 | 7 | 54 | 0 |
3 | 21 | M | Femoral neck | 12 | Spinal | 120 | 6 | 12 | 0 |
4 | 32 | M | Femoral head | 16 | Spinal | 80 | 8 | 16 | 0 |
5 | 22 | M | Femoral head | 7 | Spinal | 90 | 10 | 49 | 0 |
6 | 17 | M | Tibia | 8 | Spinal | 110 | 11 | 34 | 0 |
7 | 32 | M | Femoral head | 18 | Spinal | 100 | 10 | 38 | 0 |
8 | 22 | M | Femoral shaft | 11 | Spinal | 75 | 12 | 18 | 0 |
9 | 25 | M | Femoral head | 15 | Spinal | 85 | 8 | 15 | 0 |
10 | 23 | M | Femoral shaft | 20 | Spinal | 130 | 11 | 20 | 0 |
11 | 21 | M | Femoral head | 12 | Spinal | 55 | 11 | 28 | 0 |
12 | 27 | M | Femoral shaft | 18 | Spinal | 135 | 10 | 18 | 0 |
13 | 20 | M | Acetabulum | 9 | Spinal | 95 | 8 | 51 | 0 |
14 | 16 | M | Femoral neck | 14 | Spinal | 60 | 7 | 14 | 0 |
15 | 36 | M | Femoral head | 8 | Spinal | 65 | 9 | 39 | 0 |
16 | 22 | M | Femoral shaft | 10 | Spinal | 95 | 9 | 27 | 0 |
17 | 23 | M | Acetabulum | 14 | Spinal | 105 | 9 | 16 | 0 |
18 | 29 | M | Femoral neck | 9 | Spinal | 125 | 9 | 24 | 0 |
19 | 26 | F | Femoral neck | 19 | Spinal | 55 | 12 | 29 | 0 |
20 | 37 | F | Femoral neck | 16 | Spinal | 50 | 7 | 13 | 0 |
21 | 48 | F | Femoral head | 36 | Spinal | 110 | 12 | 36 | 0 |
Appendix 2
The questionnaire was composed of pre-operative and post-operative estimates focusing on the quantification of pain, the response to aspirin or anti-inflammatory drugs, the limitations of function, self-care, and daily or recreational activities, and the patient’s anxiety-depression of tumour recurrence.
Appendix 3
Clinical and imaging criteria for diagnosis of osteoid osteoma
Clinical criteria |
Local pain that is worse at night and rest |
Pain relief after the administration of aspirin or non-steroidal anti-inflammatory medications |
Imaging criteria |
Plain radiographs show a distinctive, small rounded area of osteolysis, the “nidus” that consists of osteoid tissue surrounded by a halo of hyperostosis |
Computed tomography scan shows a small well-delineated radiolucent nidus with dense sclerotic reaction and an increased density calcified centre. Intramedullary and juxta-articular osteoid osteomas and osteoid osteomas in cancellous bones may not show perinidal sclerosis |
Technitium-99 m (Tc-99 m) methylene diphosphonate and hydroxymethylene diphosphonate show increased radioisotope uptake at the site of tumour |
Magnetic resonance imaging shows a focal area of decreased signal intensity on T1-weighted images and variable signal intensity on T2-weighted images. On short inversion-time inversion recovery (STIR) or fat suppressed T2-weighted fast spin echo sequences, signal intensity is usually high in the bone marrow and soft-tissue oedema may be apparent |
Appendix 4
The mean scores of pain, use of medications, and activities 1 month pre-procedure
Patient | Age | Sex | Lesion location | Day pain | Night pain | Pain medication | Self-care activities | Usual activities | Recreational interests | Anxiety-depression |
|---|---|---|---|---|---|---|---|---|---|---|
1 | 23 | M | Femoral neck | 40 | 20 | 25 | 25 | 25 | 25 | 25 |
2 | 26 | M | Femoral head | 30 | 10 | 25 | 75 | 50 | 25 | 0 |
3 | 21 | M | Femoral neck | 50 | 20 | 50 | 50 | 25 | 0 | 25 |
4 | 32 | M | Femoral head | 40 | 10 | 25 | 25 | 25 | 25 | 0 |
5 | 22 | M | Femoral head | 40 | 0 | 25 | 25 | 25 | 25 | 0 |
6 | 17 | M | Tibia | 50 | 20 | 25 | 50 | 50 | 25 | 25 |
7 | 32 | M | Femoral head | 40 | 20 | 25 | 75 | 50 | 25 | 50 |
8 | 22 | M | Femoral shaft | 50 | 20 | 25 | 75 | 50 | 25 | 50 |
9 | 25 | M | Femoral head | 30 | 0 | 25 | 50 | 25 | 25 | 25 |
10 | 23 | M | Femoral shaft | 30 | 10 | 25 | 25 | 25 | 25 | 25 |
11 | 21 | M | Femoral head | 40 | 10 | 50 | 75 | 50 | 25 | 25 |
12 | 27 | M | Femoral shaft | 40 | 20 | 25 | 50 | 50 | 25 | 0 |
13 | 20 | M | Acetabulum | 50 | 10 | 25 | 50 | 25 | 25 | 0 |
14 | 16 | M | Femoral neck | 40 | 20 | 50 | 50 | 25 | 0 | 25 |
15 | 36 | M | Femoral head | 40 | 10 | 25 | 50 | 25 | 25 | 25 |
16 | 22 | M | Femoral shaft | 30 | 10 | 25 | 50 | 50 | 25 | 25 |
17 | 23 | M | Acetabulum | 30 | 10 | 25 | 25 | 25 | 25 | 25 |
18 | 29 | M | Femoral neck | 40 | 20 | 25 | 50 | 25 | 25 | 0 |
19 | 26 | F | Femoral neck | 50 | 20 | 25 | 50 | 50 | 25 | 25 |
20 | 37 | F | Femoral neck | 40 | 10 | 0 | 25 | 25 | 25 | 0 |
21 | 48 | F | Femoral head | 40 | 0 | 0 | 25 | 25 | 0 | 25 |
Appendix 5
The mean scores of pain, use of medications, and activities 1 month post-procedure
Patient | Age | Sex | Lesion location | Night pain | Day pain | Pain medication | Self-care activities | Usual activities | Recreational interests | Anxiety-depression |
|---|---|---|---|---|---|---|---|---|---|---|
1 | 23 | M | Femoral neck | 100 | 100 | 75 | 100 | 75 | 50 | 75 |
2 | 26 | M | Femoral head | 100 | 100 | 100 | 100 | 100 | 100 | 50 |
3 | 21 | M | Femoral neck | 100 | 100 | 100 | 100 | 75 | 75 | 100 |
4 | 32 | M | Femoral head | 100 | 100 | 75 | 100 | 75 | 50 | 50 |
5 | 22 | M | Femoral head | 100 | 100 | 100 | 100 | 75 | 50 | 50 |
6 | 17 | M | Tibia | 100 | 100 | 100 | 100 | 100 | 100 | 100 |
7 | 32 | M | Femoral head | 100 | 100 | 100 | 100 | 100 | 75 | 100 |
8 | 22 | M | Femoral shaft | 100 | 100 | 100 | 100 | 75 | 75 | 100 |
9 | 25 | M | Femoral head | 100 | 100 | 100 | 100 | 75 | 50 | 100 |
10 | 23 | M | Femoral shaft | 100 | 100 | 100 | 100 | 100 | 100 | 100 |
11 | 21 | M | Femoral head | 100 | 100 | 100 | 100 | 100 | 100 | 100 |
12 | 27 | M | Femoral shaft | 100 | 100 | 75 | 100 | 75 | 50 | 50 |
13 | 20 | M | Acetabulum | 100 | 100 | 100 | 100 | 100 | 75 | 50 |
14 | 16 | M | Femoral neck | 100 | 100 | 75 | 75 | 100 | 75 | 100 |
15 | 36 | M | Femoral head | 100 | 100 | 100 | 100 | 100 | 100 | 100 |
16 | 22 | M | Femoral shaft | 100 | 100 | 100 | 100 | 100 | 75 | 100 |
17 | 23 | M | Acetabulum | 100 | 100 | 100 | 100 | 75 | 50 | 100 |
18 | 29 | M | Femoral neck | 100 | 100 | 100 | 100 | 75 | 50 | 50 |
19 | 26 | F | Femoral neck | 100 | 100 | 100 | 100 | 100 | 100 | 100 |
20 | 37 | F | Femoral neck | 100 | 100 | 75 | 100 | 100 | 100 | 75 |
21 | 48 | F | Femoral head | 100 | 100 | 75 | 75 | 75 | 50 | 100 |
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Kyriakopoulos, C.K., Mavrogenis, A.F., Pappas, J. et al. Percutaneous computed tomography-guided radiofrequency ablation of osteoid osteomas. Eur J Orthop Surg Traumatol 17, 29–36 (2007). https://doi.org/10.1007/s00590-006-0121-0
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DOI: https://doi.org/10.1007/s00590-006-0121-0