Osteoid osteoma of the spine: a novel technique using combined computer-assisted and gamma probe-guided high-speed intralesional drill excision.
METHODS
A report of five cases of thoracolumbar osteoid osteoma treated with combined computer-assisted and gamma probe-guided high-speed drill excision.


OBJECTIVE
To document the surgical technique consisting of a combination of both computer-assisted and gamma probe-guided high-speed drill excision for osteoid osteoma of the spine.


BACKGROUND
Curative treatment of spinal osteoid osteoma is performed by surgical intralesional excision of the nidus, but intraoperative localization of the nidus is often difficult. Although intraoperative gamma-probe guidance facilitates accurate localization of the nidus, wide surgical resection of the bony structure is still mandatory to ensure removal of the nidus. Computer-assisted surgery has been proven to facilitate surgical intervention in spinal surgery. However, there is no clinical report regarding the application and usefulness of computer-assisted intralesional excision of the osteoid nidus. Excision of the nidus with a computer-assisted high-speed drill and intraoperative gamma probe control may result in complete intralesional excision without sacrificing more bone than necessary.


METHODS
One day before surgery, patients were injected with radioactive mTc-oxidronate. With a computed tomography-based electro-optical navigation system, real-time virtual images of the osteoid osteoma were generated by matching the intraoperative surface with preoperative computed tomography images. The osteoid osteoma was excised with the use of an image-guided high-speed drill, and complete excision was controlled with a gamma detection probe.


RESULTS
Excision of the nidus was confirmed by relief of symptoms, postexcision computed tomography scans, and histologic evaluation on clinical and radiographic follow-up observation. All five patients reported immediate complete relief of characteristic pain and no evidence of recurrence after 6 to 33 months of follow-up observation. There were no complications.


CONCLUSIONS
The combination of both computer-assisted surgery and gamma probe-guided high-speed drill excision for osteoid osteoma of the spine helps to localize and excise the nidus of the osteoid osteoma with minimal bone resection of the posterior spinal structures.
Van Royen
Barend J
BJ
Departments of Orthopaedic Surgery, VU University Medical Center, Amsterdam Spine Center, Amsterdam, The Netherlands. bj.vanroyen@vumc.nl
Baayen
Johannes C
JC
Pijpers
Rik
R
Noske
David P
DP
Schakenraad
Ditmar
D
Wuisman
Paul I J M
PI
D000293:Adolescent; D000328:Adult; D005260:Female; D015902:Gamma Cameras; D005720:Gamma Rays; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D016343:Monitoring, Intraoperative; D010017:Osteoma, Osteoid / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D015642:Radiology, Interventional / Q000379:methods*; D011877:Radionuclide Imaging; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome