Spinal Osteoid Osteoma Research Articles

Radiofrequency Ablation’s Effectiveness for Treating Abdominal and Thoracic Chronic Pain Syndromes: A Systematic Review of the Current Literature

BACKGROUND: Many patients suffer from abdominal and thoracic pain syndromes secondary to numerous underlying etiologies. Chronic abdominal and thoracic pain can be difficult to treat and often refractory to conservative management. In this systematic literature review, we evaluate the current literature to assess radiofrequency ablation’s (RFA) efficacy for treating these debilitating chronic pain conditions in the thoracic and abdominal regions. OBJECTIVES: The objective of this study is to determine the pain relief efficacy of RFA on chronic thoracic and chronic abdominal disease states. STUDY DESIGN: This study is a systematic literature review that uses the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) method to gather academic literature articles through a methodical approach. The numbers obtained from each academic manuscript were then used to calculate the percent efficacy of radiofrequency ablation on thoracic and abdominal pain relief. METHODS: Articles from 1992 through 2022 were gathered using PRISMA guidelines. The search terms “Radiofrequency Ablation Thoracic Pain” and “Radiofrequency Ablation Abdominal Pain” were used to identify articles to include in our study. Our search yielded a total of 575 studies, 32 of which were included in our study. The articles were then categorized into pain causes. The efficacy of RFA for each qualitative study was then quantified. Risk of bias was also assessed for articles using the Cochran Risk of Bias tool, as well as a tool made by the National Institutes of Health. RESULTS: The PRISMA search yielded a total of 32 articles used for our study, including 16 observational studies, one cohort study, 6 case reports, 6 case series, and 3 clinical trials. Twenty-five articles were labeled good quality and one article was labeled fair quality according to the risk of bias assessment tools. The studies examined RFA efficacy on chronic abdominal and chronic pain syndromes such as spinal lesions, postsurgical thoracic pain, abdominal cancers, and pancreatitis. Among these etiologies, RFA demonstrated notable efficacy in alleviating pain among patients with spinal osteoid osteomas or osteoblastomas, lung cancer, and pancreatic cancer. The modes of RFA used varied among the studies; they included monopolar RFA, bipolar RFA, pulsed RFA, and RFA at different temperatures. The average efficacy rate was 84% ranging from 55.8% - 100%. A total of 329 males and 291 females were included with ages ranging 4 to 90 years old. LIMITATIONS: Limitations of this review include the RFA not being performed at the same nerve level to address the same pathology and the RFA not being performed for the same duration of time. Furthermore, the efficacy of RFA was evaluated via large case series and single cohort observational studies rather than control group observational studies and clinical trial studies. CONCLUSION: A systematic review of the literature supports RFA as a viable option for managing abdominal and thoracic pain. Future randomized controlled trials are needed to investigate the efficacy of the various RFA modalities to ensure RFA is the source of pain relief as a large body of the current literature focuses only on observational studies. KEY WORDS: Chronic pain management, radiofrequency ablation, chronic abdominal pain, chronic thoracic pain, pain measurement

Use of intraoperative bone scintigraphy for resection of spinal osteoid osteoma.

The location and proximity to the spinal cord in spinal osteoid osteoma can increase the likelihood of an incomplete resection. Intraoperative bone scintigraphy (IOBS) can be used to verify location and complete surgical resection. To review our experience using IOBS for resection of intraspinal osteoid osteoma. IRB approved, retrospective review of IOBS-guided resection over 10years. Patients underwent injection of 200 uCi/kg (1-20mCi) 99mTc-MDP 3-4h prior surgery. Portable single-headed gamma camera equipped with a pinhole collimator (3- or 4-mm aperture) was used. Images were obtained pre-operatively, at the start of the procedure, and intraoperatively. Operative notes were reviewed. Evaluation of recurrence and clinical follow-up was performed. Twenty IOBS-guided resections were performed in 18 patients (median age 13.5years, 6-22years, 12 males). Size ranged 5-16mm, with 38.9% (7/18) cervical, 22.2% (4/18) thoracic, 22.2% (4/18) lumbar, and 16.7% (3/18) sacral. In all cases, IOBS was able to localize the lesion. After suspected total excision, IOBS altered the surgical plan in 75% of cases (15/20), showing residual activity prompting further resection. Median length of follow-up was 6months (range 1-156months) with 90% (18/20) showing complete resection without recurrence. Two patients had osteoid osteoma recurrence at 7 and 10months following the original resection, requiring re-intervention. IOBS is a useful tool for real-time localization and assessment of spinal osteoid osteoma resection. In all cases, IOBS was able to localize the lesion and changed surgical planning in 75% of cases. Ninety percent of patients achieved complete resection and remain recurrence free.

Spinal osteoid osteoma in the pediatric population: A management algorithm and systematic review.

The purpose of this study is to develop an accessible step-wise management algorithm for the management of pediatric spinal osteoid osteomas (OOs) based on a systematic review of the published literature regarding the diagnostic evaluation, treatment, and outcomes following surgical resection. A systematic review of the literature was conducted on PubMed to locate English language studies reporting on the management of pediatric spinal OOs. Data extraction of clinical presentation, management strategies and imaging, and treatment outcomes were performed. Ten studies reporting on 85 patients under the age of 18 years presenting with OOs were identified. Back pain was the most common presenting symptom, and scoliosis was described in 8 out of 10 studies, and radicular pain in 7 out of 10 studies. Diagnostic, intraoperative, and postoperative assessment included radiographs, computed tomography (CT) scans, magnetic resonance imaging (MRI), bone scans, and frozen section. Treatment options varied, including conservative management, open surgical resection with or without intraoperative imaging, and percutaneous image-guided treatment. All included studies described partial or complete resolution of pain in the immediate postoperative period. The proposed algorithm provides a suggested framework for management of pediatric spinal OOs based on the available evidence (levels of evidence: 3, 4). This review of the literature indicated that a step-wise approach should be utilized in the management of pediatric spinal OOs.

Letter to the Editor concerning "Radiofrequency ablation is as safe and effective as surgical excision for spinal osteoid osteoma: a systematic review and meta-analysis" by Sangiorgio A, et al. [Eur Spine J (2023): doi:10.1007/s00586-022-07411-8

Letter to the Editor concerning "Radiofrequency ablation is as safe and effective as surgical excision for spinal osteoid osteoma: a systematic review and meta-analysis" by Sangiorgio A, et al. [Eur Spine J (2023): doi:10.1007/s00586-022-07411-8

Answer to the Letter to the Editor of A. Takata, et al. concerning "Radiofrequency ablation is as safe and effective as surgical excision for spinal osteoid osteoma: a systematic review and meta-analysis" by Sangiorgio A, et al. [Eur Spine J (2023): doi:10.1007/s00586-022-07411-8

Answer to the Letter to the Editor of A. Takata, et al. concerning "Radiofrequency ablation is as safe and effective as surgical excision for spinal osteoid osteoma: a systematic review and meta-analysis" by Sangiorgio A, et al. [Eur Spine J (2023): doi:10.1007/s00586-022-07411-8

Spinal Osteoid Osteoma in L5 Vertebral Body-A Case Report and Literature Review

An osteoid osteoma (OO) is a benign bone tumour with a higher predisposition to affect long bones such as the femur and tibia, presenting in the vertebral spine in approximately 10%-25% of the cases. Clinically, pain is the most frequent symptom. Radiography should be the first imaging choice. Computed tomography (CT) is the elective exam for anatomical location of the nidus and surgical excision is the treatment of choice

Spontaneous correction of scoliosis after curettage of spinal osteoid osteoma: How and when?

BackgroundScoliosis behavior after curettage of spinal osteoid osteoma has been not clarified as most studies regarding scoliosis secondary to osteoid osteoma (OO) were case reports. The aims of this study were to investigate (1) clinical and radiographic features of scoliosis secondary to OO; (2) scoliosis behavior after Curettage of OO.MethodsA retrospective study was performed at patients who were diagnosed as OO clinically or pathologically from July 1998 to December 2019 in a single institution. Age, gender, location of pain, location of lesion and curve pattern of scoliosis were collected preoperatively. Intraoperative blood loss, operation time and surgical complications were documented. VAS scores and curve magnitude were collected pre- and postoperatively and at last follow-up.ResultsThe mean operation time was 124 ± 32 min and the average intraoperative blood loss was 274 ± 134 ml. The mean preoperative VAS score was 6.2 ± 2.7, and the mean postoperative VAS score was 2.1 ± 1.8. Thoracic scoliosis was improved from 22.7 ± 10.6° to 6.2 ± 4.3° after operation, and to 4.1 ± 4.3° at last follow-up. Lumbar scoliosis was improved from 18.1 ± 7.4° to 6.7 ± 5.2° after operation, and to 5.3 ± 3.9° at last follow-up. Trunk shift was improved from 34.7 ± 12.4 to 10.5 ± 7.2 mm after operation, and to 8.4 ± 5.6 mm at last follow-up. There was no significant differences as to sagittal radiographic parameters (P > 0.05).ConclusionPatients with spinal OO had a significantly high incidence of scoliosis. Patients could get rapid relief of pain and scoliosis with low occurrence. Night pain, pain at the concave side of curve, normal sagittal alignment could help differentiate it from scoliosis associated with lumbar disc herniation.

Radiofrequency ablation is as safe and effective as surgical excision for spinal osteoid osteoma: a systematic review and meta-analysis.

Osteoid osteoma (OO) is a primary benign tumor that affects mainly young patients. Ten percent of all OO are located in the vertebral column. Treatment of spinal OO is challenging and there is no consensus in the literature on the best operative approach. The aim of this systematic review and meta-analysis was to determine safety and efficacy of radiofrequency ablation (RFA) versus surgical excision for the treatment of spinal OO. A literature search was performed on PubMed, Web of Science, and Embase from inception up to 22 March 2022. Studies addressing surgical excision or RFA for the treatment of spinal OO were included. The main outcomes evaluated were pain before and after intervention, the treatments success rate, defined as complete pain relief with no recurrence until the last follow-up, and the number and type of complications. Thirty-one studies (749 patients) were included. For patients who underwent surgical excision, 19 studies reported a mean treatment success rate of 85.6%, while in the RFA treatment group, 18 studies reported a mean success rate of 88.6%. At last follow-up, the pooled mean difference in pain scores from baseline on a 0-10 scale was 5.8 points in the surgical excision group and 6.7 points in the RFA group. Recurrences were observed in 5.6% of the patients who underwent surgical excision and in 6.7% of the patients treated with RFA. The complication rate was 7.8% in the surgical excision group and 4.4% in the RFA group. This meta-analysis found high global success rates for both surgical and RFA treatments. Both treatments were efficient in pain relief and presented a low rate of recurrences. The complication rate was low for both treatments. Compared to surgical excision, RFA is a less invasive procedure which proved to be a safe and as effective option for the treatment of spinal OO.

Avoiding Misdiagnosis and Missed Diagnosis for Appropriately Treating Spinal Osteoid Osteomas: A Single-Center Experience.

ObjectivesTo analyze the causes of misdiagnosis and missed diagnosis in spinal osteoid osteoma, and to put forward solutions to improve diagnosis accuracy and treatment efficacy in patients.MethodsWe performed a retrospective cohort study on patients with spinal osteoid osteoma in Beijing Jishuitan Hospital from January 1983 to September 2019. All patients underwent surgery. The outcome measures were the extent of local pain, nocturnal pain, radicular symptoms of extremities after surgery, and reduction or disappearance of lesions on CT after surgery.ResultsThirty‐seven patients with spinal osteoid osteoma were recruited in the study. A total of 27% were female, and the mean (SD) age at diagnosis was 21.3 (8.7) years. A total of 87.0% of patients presented with nocturnal pain, and 94.7% of patients were responsive to NSAIDS treatment. The mean (SD) time from the initial onset of symptoms to the final diagnosis was 14.7 (12.5) months. Only four of 37 (10.8%) patients were correctly diagnosed with spinal osteoid osteoma on the first visit to the local hospital. CT is associated with a higher diagnosis rate than X‐ray or MRI on the first visit. Surgical navigation was used in 88.9% of patients who underwent curettage resection, and in 10% of patients who underwent en bloc resection. A total of 37 of 37 patients (100%) reported relief of local pain and radicular symptoms of extremities after surgery, and no recurrence of tumors was found during follow‐ups.ConclusionsSpinal CTs are recommended to be performed if osteoid osteoma is suspected based on clinical manifestation, including nocturnal pain and responsiveness to NSAIDS treatment, to avoid misdiagnosis and missed diagnosis of spinal osteoid osteoma.

Microwave Ablation of Spinal Osteoid Osteoma—Role of Air Insulation

AbstractOsteoid osteomas are benign tumors seen in children and young adults. The management options include surgical resection and percutaneous ablation. In the present scenario, percutaneous ablation is the preferred modality, as it is minimally invasive, safe, and reliable. However, when the tumor is near a heat-vulnerable structure, thermal injury can occur.We report the case of spinal osteoid osteoma in a young female that was treated by microwave ablation (MWA) with air insulation to prevent heat injury to the spinal cord. Currently, there is paucity of literature describing the use of air insulation with MWA. In this report, we describe the technique, advantages, and limitations of using air insulation with MWA.

2021 Canadian Spine Society Abstracts.

# Abstract 45. Determining clinically important improvement following surgery for degenerative conditions of the spine: analysis of the Canadian Spine Outcomes and Research Network (CSORN) Registry {#article-title-2} There is significant variability in clinically important improvement (CII)

Microwave Ablation as a Minimally Invasive Surgical Option for the Posterior Spinal Elements Osteoid Osteoma: A Case Report

We report a 24-year-old male who was presented with constant intensive low back pain on the right side for 3 years. Large doses of NSAIDs were ineffective and resulted in gastric ulcer. Magnetic resonance tomography and computed tomography imaging revealed osteoid osteoma of L3 pars interarticularis and a needle biopsy confirmed it. An innovative approach for spinal osteoid osteoma was chosen after many considerations. The patient underwent microwave ablation of the lesion in the spine.

Spinal Osteoid Osteoma Revealed by Radiculopathy: Case Report and Literature Review.

Osteoid osteoma (OO) is a benign tumor that usually occurs in long bones of young males. We report a rare case of spinal OO in a 25-year-old woman, revealed by a sciatica. Spinal radiographs and computed tomography scan were normal, although performed at 6 months of symptom evolution. On magnetic resonance imaging, however, an important edema of the right transverse process of L5 vertebrae was depicted but was inconclusive. The diagnosis of OO was finally retained on a second computed tomography scan with thinner slices focused on the edematous area. The patient had an en-bloc excision of the tumor with complete regression of symptoms. Due to the atypical clinical presentation and the absence of common findings in imaging, the diagnosis was delayed by 12 months. Radiculopathy caused by spinal OO is a rare condition with no more than 30 cases reported in the literature. In fact, spinal OO usually presents with inflammatory back pain or painful scoliosis. This case emphasizes the importance of early suspicion and diagnostic interventions in the detection and treatment of OO.

Surgery Versus Radiofrequency Ablation in the Management of Spinal Osteoid Osteomas: A Spine Oncology Referral Center Comparison Analysis of 138 Cases

Osteoid osteomas (OOs) are benign bone forming tumors that, usually, occur in the extremities, with about 10% of them arising in the spine more commonly in the posterior elements. The aim of this study is to evaluate the long-term results of patients suffering from spinal OO treated with surgery and radiofrequency ablation. This was a retrospective comparison analysis of data prospectively collected from 2 cohorts of consecutive patients diagnosed with OO of the spine treated at the same Institute from November 2002 to February 2019. The first cohort included patients submitted to an intralesional extracapsular excision of the lesion (surgery group); the second cohort included patients submitted to radiofrequency ablation (RFA group). The surgery group showed a local recurrence rate of 1.7% versus a recurrence rate of 12.5% in the RFA group with a statistically significant difference in the disease-free survival at longest follow-up (P= 0.012). No statistically significant differences were observed in local recurrence rate stratified for level and site of lesion. No complications were observed in both groups at the time of first procedure. Surgery and RFA are both safe and effective interventional procedures for the management of spinal OO, although RFA is associated with a greater recurrence rate. Treatment should be tailored according to the relationship of lesions with neural structures and to advantages and disadvantages of each technique.

Spinal osteoid osteoma: Surgical resection and review of literature.

Background: Osteoid osteoma (OO) is a rare benign tumor of the spine that involves the posterior elements with 75% tumors involving the neural arch. The common presenting symptoms include back pain, deformity like scoliosis, and rarely radiculopathy.Methods: From 2011 to 2017, we evaluated cases of OO managed by posterior surgical resection while also reviewing the appropriate literature.Results: We assessed five patients (three males and two females) averaging 36.60 years of age diagnosed with spinal OOs. Two involved the lumbar posterior elements, two were thoracic, and one was in the C3 lateral mass. All patients underwent histopathological confirmation of OO. They were managed by posterior surgical resection with/without stabilization. No lesions recurred over the minimum follow-up period of 24 months.Conclusion: Surgical excision is the optimal treatment modality for treating spinal OOs. The five patients in this study demonstrated good functional outcomes without recurrences. Further, the literature confirms that the optimal approach to these tumors is complete surgical excision with/without radiofrequency ablation.

Percutaneous Endoscopic Excision and Ablation of Osteoid Osteoma of the Lumbar Spine and Sacrum: A Technical Note and Outcomes

This study aimed to present a new endoscopic technique for osteoid osteoma (OO) of the lumbar spine and sacrum and to evaluate its safety and effectiveness. Eleven consecutive patients with spinal OO underwent percutaneous endoscopic excision and ablation (PEEA) between March 2014 and May 2018. A cannula 0.7 cm in diameter was used for the procedure. According to the size of the nidus, whole-piece removal and piecemeal intralesional resection were used. Afterward, ablation was performed using an endoscopic radiofrequency electrode in the residual osteoma cavities. Clinical outcomes were assessed by Visual Analog Scale (VAS) scores. The efficacy of this technique was assessed using relevant clinical data and postoperative radiographs. The niduses of the 11 patients were all located in the posterior element of the lumbar spine and sacrum (10 in the lumbar spine and 1 in the sacrum). The preoperative VAS score was 7.18 (range, 6-9), the score on postoperative day 1 was 1 (range, 0-2), and the last follow-up VAS score was 0.27 (range, 0-1). All patients were discharged within 24 hours after surgery. The mean follow-up period was 21.8 months (range, 12-36 months). No serious complications were observed during the follow-up period. PEEA is a safe and effective technique for OO in the lumbar spine and sacrum in which the nidus is located in the posterior element. However, it has a steep learning curve. Further research with a larger and more comprehensive sample population is warranted.

Correction to: European multicentre study on technical success and long-term clinical outcome of radiofrequency ablation for the treatment of spinal osteoid osteomas and osteoblastomas

The original version of this paper contained an error: the Acknowledgements weredropped duringearly manuscript editing.

European multicentre study on technical success and long-term clinical outcome of radiofrequency ablation for the treatment of spinal osteoid osteomas and osteoblastomas.

To evaluate technical success and long-term outcome of CT-guided radiofrequency ablation (RFA) of spinal osteoid osteomas (OO) and osteoblastomas (OB) in six different European centres. Eighty-seven patients with spinal OO (77) or OB (10) were treated with CT-guided RFA, after three-dimensional CT-guided access planning. Patient's long-term outcome was assessed by clinical examination and questionnaire-based evaluation including 10-point visual analogue scales (VAS) regarding the effect of RFA on severity of pain and limitations of daily activities. Clinical success was defined as a reduction of > 30% in the VAS score and patient's satisfaction. Overall, RFA was technically successful in 82/87 cases (94.3%) with no major complications; clinical success was achieved in 78/87 cases (89.7%). The OO/OB were localized in the cervical (n = 9/3), the thoracic (n = 27/1), the lumbar (n = 29/4), and the sacral spine (n = 12/2). A decrease in severity of pain after RFA was observed in 86/87 patients (98.9%) with a persistent mean reduction of overall pain score from 8.04 ± 0.96 to 1.46 ± 1.95 (p < 0.001) after a median follow-up time of 29.35 ± 35.59months. VAS scores significantly decreased for limitations of both daily (5.70 ± 2.73 to 0.67 ± 1.61, p < 0.001) and sports activities (6.40 ± 2.58 to 0.67 ± 1.61, p < 0.001). In a multicentric setting, this trial proves RFA to be a safe and efficient method to treat spinal OO/OB and should be regarded as first-line therapy after interdisciplinary case discussion.

Spinal Osteoid Osteoma and scoliosis: who is the painful?

Ten-year-old girl was referred to our clinic for back pain and stiffness of the spine. X-ray of the spine showed a dorsal scoliosis with no other abnormality (figure 1a). Computed Tomography (CT) showed the nidus in right pedicle of the 3rd lumbar vertebra (figure 1b). The diagnosis of Osteoid osteoma was retained and confirmed after surgical resection and pathological examination. Osteoid osteoma (O.O) accounts for 10 % to 20 % of benign bone tumors [1]. Up to 25% of all O.O are found in the spine. Two thirds of spinal O.O manifest as painful scoliosis [2]. The diagnosis of the tumor is usually delayed because easily missed on standard X-ray investigation. Systematic CT or MRI with dynamic contrast would be recommended for young patients presenting with painful scoliosis [3].

Percutaneous Radiofrequency Ablation of Spinal Osteoid Osteomas Using a Targeted Navigational Bipolar Electrode System.

Safe and effective percutaneous CT-guided radiofrequency ablation of spinal osteoid osteomas can be performed using a targeted navigational bipolar electrode system. Articulating bipolar electrodes with built-in thermocouples along an electrode shaft and variable generator wattage settings allow optimal nidus access, particularly in challenging locations; provide precise real-time monitoring of ablation zone volume and geometry; and minimize the risk of undesired thermal injury.