Radiofrequency ablation of osteoid osteoma in atypical locations: a case series

Abstract

Background: Osteoid osteoma has a nidus surrounded by sclerotic bone with a size usually less than 20 mm. Its diagnosis is made on typical presentation of nocturnal pain and imaging findings. Excision of the niduses, which are often small and difficult to precisely identify, sometimes may result in resection of surrounding normal bone. Minimally invasive percutaneous treatments have been used to try to minimize resection of normal bone. Although minimally invasive radiofrequency ablation generally relieves pain, its ability to relieve pain is less well known in locations other than lower extremity long bones.

Questions/purposes: We determined the pain relief and complication rates after radiofrequency ablation of osteoid osteomas presenting in atypical locations and followed patients to assess possible recurrence or late complications.

Patients and methods: We retrospectively reviewed 21 patients with osteoid osteomas in unusual locations (eg, hip, radioulnar joint, and proximal phalanx) in whom we used radiofrequency ablation. Postoperative activities were not restricted for any of the patients. We assessed the time for patients to become symptom free, their activity status, and possible recurrence or complications. The minimum clinical followup was 12 months (mean, 27.8 months; range, 12-37 months).

Results: All patients became symptom free within 24 hours to 1 week. During followup, none of the patients experienced recurrence or any major complications.

Conclusions: Radiofrequency ablation for osteoid osteomas in unusual locations reliably relieves pain with few complications and recurrences at short-term followup.

Level of evidence: Level IV, case series. See Guidelines for Authors for a complete description of level of evidence.

Fig. 1A–D

RFA for a 6-mm-diameter OO of the talus in a 16-year-old boy is shown. CT scans show (A) the medullary nidus with surrounding sclerosis, (B) driving the coaxial guide toward the nidus, (C) drilling the track up to the nidus, and (D) the radiofrequency needle in the nidus.

Fig. 2A–D

RFA for a 6-mm-diameter OO in the neck of the scapula in an 11-year-old boy is shown. The posterior approach is used to avoid anterior neurovascular structures. CT scans show (A) the medullary nidus with surrounding sclerosis, (B) driving the coaxial guide toward the nidus, (C) drilling the track up to the nidus, and (D) the radiofrequency needle in the nidus.

Fig. 3A–C

RFA for a 10-mm-diameter OO of C6 in a 17-year-old girl is shown. (A) Because of the risky position, drilling was not performed, and (B) the coaxial guide provided the track for the radiofrequency needle. (C) The radiofrequency needle is shown in the nidus.

Fig. 4A–B

(A) An intraarticular OO of the acetabulum with an 11-mm-diameter nidus and (B) the radiofrequency needle placed in its nidus are shown. Surgical treatment of this lesion is difficult with possible major disabilities.