Clinical long-term outcome, technical success, and cost analysis of radiofrequency ablation for the treatment of osteoblastomas and spinal osteoid osteomas in comparison to open surgical resection.

OBJECTIVE: To assess the clinical success and costs of computed tomography (CT)-guided radiofrequency ablation (RFA) of osteoblastoma (OB) and spinal osteoid osteoma (OO). MATERIALS AND METHODS: Nineteen patients with OB and eight patients with spinal OO were treated with CT-guided RFA. The OBs were localized in the extremities (n = 10), the vertebral column (n = 2), and (juxta-)articular (n = 7). Dedicated procedural techniques included three-dimensional CT-guided access planning in all cases, overlapping RFA needle positions (median, two positions; range, 1-6 RF-electrode positions) within the OB nidus (multiple ablation technique, n = 15), and thermal protection in case of adjacent neural structure in four spinal OO. The data of eight operated OB and ten operated spinal OO patients were used for comparison. Long-term success was assessed by clinical examination and using a questionnaire sent to all operated and RFA-treated patients including visual analogue scales (VAS) regarding the effect of RFA on severity of pain and limitations of daily activities (0-10, with 0 = no pain/limitation up to 10 = maximum or most imaginable pain/limitation). RESULTS: All patients had a clear and persistent pain reduction until the end of follow-up. The mean VAS score for all spinal OO patients and all OB patients treated either with RFA or with surgical excision significantly decreased for severity of pain at night, severity of pain during the day, and both for limitations of daily and of sports activities. CONCLUSIONS: RFA is an efficient method for treating OB and spinal OO and should be regarded as the first-line therapy after interdisciplinary individual case discussion.

Treatment of osteoid osteoma using CT-guided radiofrequency ablation versus MR-guided laser ablation: a cost comparison.

OBJECTIVE: To compare the costs of CT-guided radiofrequency ablation (RFA) and MR-guided laser ablation (LA) for minimally invasive percutaneous treatment of osteoid osteoma. MATERIALS AND METHODS: Between November 2005 and October 2011, 20 patients (14 males, 6 females, mean age 20.3±9.1 years) underwent CT-guided RFA and 24 patients (18 males, 6 females; mean age, 23.8±13.8 years) MR-guided LA (open 1.0 Tesla, Panorama HFO, Philips, Best, Netherlands) for osteoid osteoma diagnosed on the basis of clinical presentation and imaging findings. Prorated costs of equipment use (purchase, depreciation, and maintenance), staff costs, and expenditure for disposables were identified for CT-guided RFA and MR-guided LA procedures. RESULTS: The average total costs per patient were EUR 1762 for CT-guided RFA and EUR 1417 for MR-guided LA. These were (RFA/LA) EUR 92/260 for equipment use, EUR 149/208 for staff, and EUR 870/300 for disposables. CONCLUSION: MR-guided LA is less expensive than CT-guided RFA for minimally invasive percutaneous ablation of osteoid osteoma. The higher costs of RFA are primarily due to the higher price of the disposable RFA probes.

[CT-controlled thermocoagulation of osteoid osteoma in comparison with traditional methods]. / Die CT-gesteuerte Thermokoagulation des Osteoidosteoms im Vergleich zu traditionellen Verfahren.

QUESTION: What are the advantages of CT-guided radiofrequency ablation in comparison to traditional techniques? METHODS: 91 patients with Osteoid Osteoma were analyzed. 15 patients were treated by a wide excision removing a bone block. 26 patients had a marginal resection removing the entire nidus. 36 patients had intralesional margins by curettage or high speed burr technique. Four patients were treated percutaneously by CT-guided drilling technique. 10 patients were treated with the new CT-guided radiofrequency ablation technique. RESULTS: Patients treated by a wide excisional margin had an average procedural length of 2 hours 45 minutes and an average hospital stay of 5 days. Cost figures totaled $13,826. One patient in this group required a bone graft. All patients had a non weight bearing status for six weeks and were limited for ten weeks on average. After marginal resections procedure length was 3 hours. Patients required an hospital stay of 3 days and cost data showed an amount of $10,857.28. 2 patients requiring bone grafts. All patients required post op casting, crutches or braces. Intralesional resection showed a procedure length of 2 hours 40 minutes with an hospital stay of 5 days. Cost figures showed an amount of $10,992. Recovery time was on average of 7 weeks. A cast was applied to three patients post op and one patient did require bone grafting due to the resulting defect. The percutaneous CT-guided burr ablation technique took 2 1/2 hours and the patients required overnight hospital stays for pain control. The costs added to $8589.80. One patient developed a non displaced fracture. For the new CT-guided Radiofrequency ablation technique the average time was 2 hours 10 minutes. Only one patient required an overnight hospital stay. Average total costs for these patients were $6583.66. 1 week post procedure all patients were free of symptoms and resumed full weight bearing. There has been no evidence of recurrence and all patients were symptom free at last contact. CONCLUSION: CT-guided radiofrequency ablation allows the orthopaedic surgeon to heal osteoid osteoma with minimal trauma, functional restrictions and costs.