Percutaneous Osteoid Osteoma Ablation

Background and indications

Osteoid osteoma is a benign bone tumor, typically painful (nocturnal pain relieved by aspirin), affecting children and young adults. CT-guided percutaneous radiofrequency ablation (RFA) is the reference treatment, having replaced surgery in the vast majority of cases. The technique was first described by Rosenthal in 1992.

Pre-procedure assessment

Assessment includes thin-slice CT of the affected area (nidus identification, typically < 15 mm), and possibly MRI and/or bone scintigraphy. The typical appearance (nidus with peripheral reactive sclerosis) is often sufficient for diagnosis without biopsy.

Procedure

Under general anesthesia (the procedure is painful during cortical drilling), a bone drill needle is inserted under CT guidance to the nidus. A radiofrequency electrode is then introduced into the nidus and a heating cycle at 90°C for 6-8 minutes is performed, destroying the nidus. The procedure takes 30 to 60 minutes.

Results and scientific evidence

RFA ablation of osteoid osteoma offers 90-95% primary success rate and 98-100% success after retreatment (Rosenthal et al., Radiology, 2003; DOI: 10.1148/radiol.2291020248). Pain relief is immediate in 90% of cases (upon anesthesia recovery). Recurrence rate is 5-10%, treatable with a second RFA session.

Risks and complications

Post-procedural pain (20-30%, transient 2-3 days), fracture (< 1%, mainly femoral neck), nerve injury (< 1%, for spinal locations or nerve proximity), skin burn (< 0.5%). Major complications are exceptional.

Recovery

Return to activities the following day in most cases. Weight-bearing protection for 2-4 weeks if on a weight-bearing bone (femur). No systematic follow-up needed if symptoms resolve.

Practical information

The procedure is performed as an outpatient or short inpatient stay depending on the case. It is performed by an interventional radiologist.