Taming Pain the New Way

Percutaneous Radiofrequency Ablation
for Osteoid Osteoma

Osteoid Osteoma is an extremely painful benign skeletal tumour seen mostly in young individuals. Anti-inflammatory medications have been traditionally used for the management of pain related to it. Although surgery is the definitive treatment, difficulty in lesion localisation and the need for extensive dissection poses a problem. Radiofrequency Ablation (RFA) has been found to be a safe, fast and reliable method of treating Osteoid Osteomas.

THE CASE

A 27 year old male visited BLK with complaints of on and off pain around his left hip for the past 12 months. His pain, usually worse during the night, showed symptomatic improvement with analgesics. On MRI investigation, it was diagnosed as Osteoid Osteoma of head and neck junction, and CT scan was done to confirm nidus. RFA was chosen as it was a difficult location to remove by open surgery because of the size and risk of AVN (Avascular Necrosis).

THE PROCEDURE

The lesions were localised with the help of a multidetector-row CT scanner. Multiplanar evaluation was done to confirm accurate needle position within the nidus. After skin preparation and proper sterilisation, local anaesthesia was administered with deep sedation. The position of the lesion, ease of access and the relationship with adjacent neurovascular structures were assessed. To minimise the possibility of thermal burns, the tip of the probe was inserted deep so that it did not lie near the skin surface. An 11-gauge bone biopsy needle was introduced into the lesion under CT guidance. Under aseptic precautions, a 12-cm long, 14-gauge side-deployment electrode was then introduced into the Osteoid Osteoma nidus through a coaxial system. The electrode was connected to the RF generator and the tip temperature was increased to 90°C. RFA was performed at 90°C for a minimum of 5 minutes. After the procedure, a small pressure dressing was applied at the percutaneous puncture site.

THE RESULT

Short term follow-up was excellent. The patient is now completely pain free and does not require any analgesic.

DISCUSSION

Difficulty in lesion localisation, the consequences of extensive dissection, the need for prolonged recuperation as well as the risk of incomplete removal and therefore recurrence of the lesion makes surgery a less desired option in the management of Osteoid Osteomas. RFA, on the other hand, has proved to be a safe, quick, and minimally invasive method of management.


Ishwar Bohra

Dr. Ishwar Bohra
Sr. Consultant
BLK Centre for Orthopaedics,
Joint Reconstruction
& Spine Surgery
BLK Super Speciality
Hospital, New Delhi

Dr. G. Prem Kumar
Radiology BLK Super Speciality Hospital, New Delhi





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