CT-guided percutaneous drilling is a safe and reliable method of treating osteoid osteomas

Abstract

Computed tomography (CT)-guided percutaneous drilling is an alternative for osteoid osteoma treatment. This study aims to evaluate the remodeling of the drill orifice. The success rate and complications were also recorded and compared with other treatment methods. Fifteen patients with an average age of fourteen years (ranging from 4 to 25) submitted to CT-guided percutaneous drilling between 2003 and 2009 were retrospectively analyzed according to clinical and radiological criteria. Fourteen cases showed complete alleviation of pain one week after surgery. No relapse was detected even in the subject who continued complaining of pain. All patients were treated with a day-hospital regimen and were discharged with partial weight bearing. Total weight bearing was allowed after one month, and sports were allowed after consolidation, which occurred in all but one case after the third month. One patient, who did not follow our medical advice, returned to sports activities after two weeks and experienced a fracture as a result. Atrophy of the vastus lateralis muscle developed after the procedure in another patient. Our case series suggests that this method is reliable and safe. The level of complexity is comparable with other minimally invasive percutaneous procedures. The cost is low because there is no need to buy probes or other equipment. The negative points include weakening of the bone and the logistical problem of assembling the orthopedic surgeon, radiologist, and anesthesiologist in the tomography room.

Keywords: Bone neoplasms; Bone remodeling; Interventional radiography; Osteoid osteoma; Treatment outcome.

Figure 1

A. CT showing the well positioned K-wire (white arrow). Access to the nidus (black arrow) via the opposite cortex was useful in this case to avoid the neurovascular bundle. B. CT after resection. Note that the cortex was not totally drilled. The black dashed arrow indicates the remaining cortex. Small bone debris was left in the path and is considered harmless (dashed white arrow).

Figure 2

Graph showing the percentage of patients in each phase of bone remodeling according to the follow-up time. (Phase 1, hole; phase 2, shadow; phase 3, callus; phase 4, remodeled).