Thermal ablation of spinal osteoid osteomas close to neural elements: technical considerations.
OBJECTIVE
The purpose of this study was to evaluate experience with and determine the efficacy and safety of thermal ablation in the management of spinal osteoid osteomas close to neural elements.


METHODS
The records of all patients with osteoid osteomas of the spine managed with thermal ablation at two academic centers from 1993 to 2008 were reviewed.


RESULTS
Seventeen patients (13 male patients, four female patients; mean age, 25.9 years) had lesions in the lumbar (seven patients), thoracic (six patients), cervical (three patients), and sacral (one patient) regions of the spine. Two lesions were in the vertebral body, one was within the dens, and the others were in the posterior elements. The mean lesion diameter was 8.8 mm, and the mean distance between the lesion and the closest neural element was 4.3 mm. The lesions were managed with laser (13 lesions) or radiofrequency (four lesions) ablation. Special thermal protection techniques involving the epidural injection of gas or cooled fluid were used. Pain levels were assessed immediately before the procedure and on the day after the procedure. Long-term follow-up findings were available for 11 patients. No complications were encountered, and all patients reported relief of pain. The 11 patients who participated in long-term follow-up reported continued relief of pain.


CONCLUSIONS
Percutaneous thermal ablation can be used to manage spinal osteoid osteomas close to the neural elements. Special thermal protection techniques may add a margin of safety.
Rybak
Leon D
LD
Department of Radiology, New York University Hospital for Joint Diseases, New York, NY 10003, USA. Leon.Rybak@nyumc.edu
Gangi
Afshin
A
Buy
Xavier
X
La Rocca Vieira
Renata
R
Wittig
James
J
D000293:Adolescent; D000328:Adult; D017115:Catheter Ablation / Q000009:adverse effects; D002648:Child; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects; D008297:Male; D010017:Osteoma, Osteoid / Q000601:surgery*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000209:etiology / Q000517:prevention & control; D013125:Spinal Neoplasms / Q000601:surgery*; D055815:Young Adult