eMedicine Specialties > Radiology > Musculoskeletal

Osteoid Osteoma: Follow-up

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist and Honorary Professor, North Manchester General Hospital Pennine Acute NHS Trust, UK
Coauthor(s): Muthusamy Chandramohan, MBBS, DMRD, FRCR, Consultant Radiologist, Bradford Teaching Hospitals, UK; Ian Turnbull, MB, ChB, MD, DMRD, FRCR, Lecturer, Department of Radiology, University of Manchester; Consulting Neuroradiologist, Hope Hospital, Salford, Manchester and North Manchester General Hospital, UK; Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Contributor Information and Disclosures

Updated: Sep 1, 2009

Intervention

Several techniques are available for ablation of osteoid osteoma. The tumor can be percutaneously ablated by using radiofrequency (RF), ethanol, laser, or thermocoagulation therapy under CT guidance. In spinal tumors, complete ablation or resection of the tumor is desirable but not always feasible.15,16,17,18,19,20,21,22,23

Percutaneous RF ablation is performed under CT guidance by using general or spinal anesthesia.24 After localization of the nidus with 1- to 3-mm CT sections, an osseous access is established with either a 2-mm coaxial drill system or an 11-gauge Jamshidi needle. RF ablation is performed at 90°C for 4-5 minutes by using a rigid RF electrode with a 1-mm diameter. The procedure is successful when the electrode is heated to the desired temperature within the nidus. In one series, clinical success was achieved in 96% of patients. All recurrences were treated with a second procedure, with a secondary success rate of 100%.

CT-guided percutaneous drilling of the nidus with subsequent ethanol injection to cause sclerosis in the remnants of the nidus has been achieved in a small series of patients. Percutaneous thermocoagulation under CT guidance has been performed to achieve ablation of a spinal osteoid osteoma.

Frequently, lesions are located near the joint surface, involve the vertebral body, or are close to major nerves. To determine whether RFA can safely be used in these cases, a study on an animal model was conducted.25 The study revealed the insulative effect of cortical bone. The authors showed that RFA always respected cortical bone, and therefore, articular cartilage was not damaged.  RFA can therefore can be safely performed close to the joint surface without damaging the cartilage. There were no significant differences in lesion size, probe type, and the duration of the procedure.

Medicolegal Pitfalls

  • Because backache is common, symptoms of an osteoid osteoma may be ignored, or an osteoid osteoma may not be considered as the cause.
  • In one series, the average time from symptom onset to diagnosis was 28 months.
    • The longer the duration of the symptoms, the lower the likelihood of complete correction of scoliosis associated with osteoid osteoma.
    • Isotope bone scanning may reduce the time to diagnosis, and a scan may demonstrate positive findings in the absence of radiographic changes.
    • Painful scoliosis is an indication for a radionuclide study.
  • The diagnosis of intra-articular osteoid osteoma often is delayed because it may be confused with other forms of monoarthritis. Therefore, osteoid osteoma should always be considered in the differential diagnosis of monoarticular pain.
 


More on Osteoid Osteoma

Overview: Osteoid Osteoma
Imaging: Osteoid Osteoma
Follow-up: Osteoid Osteoma
Multimedia: Osteoid Osteoma
References
Further Reading
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References

  1. Shukla S, Clarke AW, Saifuddin A. Imaging features of foot osteoid osteoma. Skeletal Radiol. Jul 15 2009;[Medline].

  2. von Kalle T, Langendörfer M, Fernandez FF, Winkler P. Combined dynamic contrast-enhancement and serial 3D-subtraction analysis in magnetic resonance imaging of osteoid osteomas. Eur Radiol. May 15 2009;[Medline].

  3. Aynaci O, Turgutoglu O, Kerimoglu S, Aydin H, Cobanoglu U. Osteoid osteoma with a multicentric nidus: a case report and review of the literature. Arch Orthop Trauma Surg. Dec 2007;127(10):863-6. [Medline].

  4. Kan P, Schmidt MH. Osteoid osteoma and osteoblastoma of the spine. Neurosurg Clin N Am. Jan 2008;19(1):65-70. [Medline].

  5. Rajasekaran S, Kamath V, Shetty AP. Intraoperative Iso-C three-dimensional navigation in excision of spinal osteoid osteomas. Spine. Jan 1 2008;33(1):E25-9. [Medline].

  6. Moser T, Giacomelli MC, Clavert JM, Buy X, Dietemann JL, Gangi A. Image-guided laser ablation of osteoid osteoma in pediatric patients. J Pediatr Orthop. Mar 2008;28(2):265-70. [Medline].

  7. Murphy K, Baez JC, Cooney B, Kabaish K. CT Fluoroscopy-guided Postmyelographic Transthecal Radiofrequency Ablation of a Posterior Vertebral Body Osteoid Osteoma. J Vasc Interv Radiol. Feb 2008;19(2):291-3. [Medline].

  8. Donkol RH, Al-Nammi A, Moghazi K. Efficacy of percutaneous radiofrequency ablation of osteoid osteoma in children. Pediatr Radiol. Feb 2008;38(2):180-5. [Medline].

  9. Davies AM, Wellings RM. Imaging of bone tumors. Curr Opin Radiol. 1992;4(6):32-8. [Medline].

  10. Tumeh SS. Scintigraphy in the evaluation of arthropathy. Radiol Clin North Am. Mar 1996;34(2):215-31, ix. [Medline].

  11. Spouge AR, Thain LM. Osteoid osteoma: MR imaging revisited. Clin Imaging. Jan-Feb 2000;24(1):19-27. [Medline].

  12. Ebrahim FS, Jacobson JA, Lin J, et al. Intraarticular osteoid osteoma: sonographic findings in three patients with radiographic, CT, and MR imaging correlation. AJR Am J Roentgenol. Dec 2001;177(6):1391-5. [Medline].

  13. Gil S, Marco SF, Arenas J, et al. Doppler duplex color localization of osteoid osteomas. Skeletal Radiol. Feb 1999;28(2):107-10. [Medline].

  14. Perkins AC, Hardy JG. Intra-operative nuclear medicine in surgical practice. Nucl Med Commun. Dec 1996;17(12):1006-15. [Medline].

  15. Adam G, Neuerburg J, Vorwerk D, et al. Percutaneous Treatment of Osteoid Osteomas: Combonation of Drill Biopsy and Subsequent Ethanol Injection. Semin Musculoskelet Radiol. 1997;1(2):281-284. [Medline].

  16. Cove JA, Taminiau AH, Obermann WR, Vanderschueren GM. Osteoid osteoma of the spine treated with percutaneous computed tomography-guided thermocoagulation. Spine. May 15 2000;25(10):1283-6. [Medline].

  17. Donley BG, Philbin T, Rosenberg GA, et al. Percutaneous CT guided resection of osteoid osteoma of the tibial plafond. Foot Ankle Int. Jul 2000;21(7):596-8. [Medline].

  18. Dupuy DE, Goldberg SN. Image-guided radiofrequency tumor ablation: challenges and opportunities--part II. J Vasc Interv Radiol. Oct 2001;12(10):1135-48. [Medline].

  19. Lindner NJ, Ozaki T, Roedl R, et al. Percutaneous radiofrequency ablation in osteoid osteoma. J Bone Joint Surg Br. Apr 2001;83(3):391-6. [Medline].

  20. Woertler K, Vestring T, Boettner F, et al. Osteoid osteoma: CT-guided percutaneous radiofrequency ablation and follow-up in 47 patients. J Vasc Interv Radiol. Jun 2001;12(6):717-22. [Medline].

  21. Lee MH, Ahn JM, Chung HW, Lim HK, Suh JG, Kwag HJ. Osteoid osteoma treated with percutaneous radiofrequency ablation: MR imaging follow-up. Eur J Radiol. Nov 2007;64(2):309-14. [Medline].

  22. Bruners P, Penzkofer T, Günther RW, Mahnken A. [Percutaneous radiofrequency ablation of osteoid osteomas: technique and results]. Rofo. Aug 2009;181(8):740-7. [Medline].

  23. Hoffmann RT, Jakobs TF, Kubisch CH, Trumm CG, Weber C, Duerr HR, et al. Radiofrequency ablation in the treatment of osteoid osteoma-5-year experience. Eur J Radiol. Jan 12 2009;[Medline].

  24. Sung KS, Seo JG, Shim JS, Lee YS. Computed-tomography-guided percutaneous radiofrequency thermoablation for the treatment of osteoid osteoma-2 to 5 years follow-up. Int Orthop. Nov 22 2007;[Medline].

  25. Martel J, Bueno A, Domínguez MP, Llorens P, Quirós J, Delgado C. Percutaneous radiofrequency ablation: relationship between different probe types and procedure time on length and extent of osteonecrosis in dog long bones. Skeletal Radiol. Feb 2008;37(2):147-52. [Medline].

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Further Reading

Related eMedicine topics

Osteoid Osteoma (Orthopedic Surgery)

Bone Infarct

Bone Island

Bone Metastases

Legg-Calve-Perthes Disease

Lymphoma, Bone

Osteoblastoma

Osteomyelitis, Chronic

Stress Fracture

Clinical guidelines

ACR Appropriateness Criteria® bone tumors. American College of Radiology - Medical Specialty Society.  1995 (revised 2005).  5 pages.  NGC:004783

ACR Appropriateness Criteria® chronic hip pain. American College of Radiology - Medical Specialty Society.  1998 (revised 2008).  8 pages.  NGC:006998

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Keywords

osteoid osteoma, sclerotic bone island, benign bone neoplasm, benign skeletal neoplasm, bone lesion, bone neoplasm, skeletal lesion, skeletal neoplasm, cortical bone sclerosis, endosteal bone sclerosis, bone sclerosis, osteoblastic rimming, osteoblastoma, giant osteoid osteoma

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Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist and Honorary Professor, North Manchester General Hospital Pennine Acute NHS Trust, UK
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR is a member of the following medical societies: American Association for the Advancement of Science, American Institute of Ultrasound in Medicine, British Medical Association, British Society of Interventional Radiology, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Muthusamy Chandramohan, MBBS, DMRD, FRCR, Consultant Radiologist, Bradford Teaching Hospitals, UK
Disclosure: Nothing to disclose.

Ian Turnbull, MB, ChB, MD, DMRD, FRCR, Lecturer, Department of Radiology, University of Manchester; Consulting Neuroradiologist, Hope Hospital, Salford, Manchester and North Manchester General Hospital, UK
Disclosure: Nothing to disclose.

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Medical Editor

Leon Lenchik, MD, Director, Densitometry Minifellowship, Assistant Professor, Department of Radiology, Wake Forest University Medical Center
Leon Lenchik, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Murali Sundaram, MBBS, FRCR, FACR, Consulting Staff, Department of Diagnostic Radiology, The Cleveland Clinic Foundation
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, EdM, Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington
Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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