3D imaging and stealth navigation instead of CT guidance for radiofrequency ablation of osteoid osteomas: a series of 52 patients

Ran Ankory,Ran Ankory,Shlomo Dadia,Haggai Schermann,Haggai Schermann,Assaf Kadar,Assaf Kadar,Yair Gortzak,Yair Gortzak,Yehuda Kollander,Yehuda Kollander,Doron Netzer,Doron Netzer,Ortal Segal,Ortal Segal

doi:10.1186/s12891-019-2963-8

Abstract

BackgroundOsteoid osteomas are benign bone neoplasms that may cause severe pain and limit function. They are commonly treated by radiofrequency ablation (RFA) through a needle inserted into the nidus of the lesion under CT guidance, which is associated with exposure of young patients to relatively high dose of radiation. The objective of this study was to investigate the amount of radiation, effectiveness and safety of an alternative imaging approach, the 3D image-guided (O-arm) technology and the Stealth navigation.MethodsWe retrospectively reviewed 52 electronic medical files of patients (mean age 24.7 years, range 8–59 years) who were treated with thermal ablation of benign osteoid osteomas guided by the navigated O-arm-assisted technique in our institution between 2015 and 2017. Data were extracted on the associated complications, the reduction in pain at 3 months and one year postoperatively, and the amount of radiation administered during the procedure.ResultsThe level of pain on a visual analogue scale decreased from the preoperative average of 7.73 to 0 at the 3-month follow-up. The mean dose-length product was 544.7 mGycm2 compared to the reported radiation exposure of 1971–7946 mGycm2 of CT-guided radio ablations. The one intra-operative complication was a superficial burn in the subcutaneous lesion in a tibia that was treated locally with no major influence on recovery.ConclusionsRFA ablation guided by 3D O-arm stealth navigation is as effective as the traditional CT-guided technique with the advantage of lower radiation exposure.Trial registrationRetrospective study number 0388–17-TLV at Tel Aviv Sourasky Medical Center IRB, approved at 25.10.17.

Highlights

Osteoid osteomas are benign bone neoplasms that may cause severe pain and limit function
The goals of this study were, to describe a new technique that utilizes a navigation system combined with an O-arm that can help direct the surgeon into bony lesions with minimal radiation to the patient and staff compared to conventional computerized tomographic (CT)-guided procedures
Radiation exposure was quantified by dose-length product (DLP), which is a measurement calculated by the scan length, and the volume CT dose index (CTI)

Summary

Introduction

Osteoid osteomas are benign bone neoplasms that may cause severe pain and limit function. Osteoid osteomas account for 10– 12% of all benign bone lesions and mostly affect patients between 5 to 24 years of age [1] They are a self-limited condition, and are usually resolved without treatment within 1–7 years [1], but many patients require surgical intervention in order to decrease pain and regain function. Until the late 1990’s, the surgical treatment for osteoid osteomas consisted mainly of complete open resection [2]. This treatment was very effective but had several disadvantages. Resection of a tumor in a weight-bearing bone might require restrictions of activities or even prophylactic fixation

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