title: Percutaneous Image-guided Laser Photocoagulation of Spinal Osteoid Osteoma: A Single-Institution Series.
abstract: OBJECTIVE
  To retrospectively evaluate the safety and efficacy of percutaneous image-guided laser photocoagulation for the treatment of spinal osteoid osteoma (OO) in proximity to neural structures.
  
  
  METHODS
  This study was institutional review board-approved with waivers of informed consent. From January 1994 until October 2014, 58 patients with spinal OO (mean age, 25 years; 40 men, 17 women) were treated in one institution by using laser photocoagulation with combined computed tomographic (CT) and fluoroscopic guidance. One patient was excluded because of less than 3 months of follow-up. All patients had typical clinical and imaging findings. Clinical features, radiologic data, and procedure-related data were reviewed, and limitations, complications, and failure rate were evaluated. All data were expressed as means ± standard deviation. P values of less than .05 were indicative of statistical significance.
  
  
  RESULTS
  OO was in the vertebral body for 18 of 57 patients, the neural arch for 21 of 57 patients, and the articular process for 18 of 57 patients. Mean nidal diameter was 8 mm, and the mean distance from the closest neural structure was 6.6 mm (minimum distance, ≤5 mm in 35 of 57 patients). In 35 of 57 patients, no cortical coverage was present between the nidus and neural structure in danger. Mean total energy delivered was 1271 J (2-watt continuous power mode). Thermal insulation (carbon dioxide and/or hydrodissection), temperature monitoring, and electrostimulation were used in 42, 24, and one patient, respectively. Primary clinical success at 1 month was 98.2%. Total recurrence rate was 5.3%. All recurrences were addressed percutaneously. Secondary success rate was 100%. One-year follow-up is available in 54 of 57 patients. No major complications were noted.
  
  
  CONCLUSIONS
  Spinal OO can be safely and effectively treated with percutaneous laser photocoagulation. In cases that are less than 8 mm to 10 mm distance and in the absence of cortical coverage, thermal protection techniques of the neural structures should be used.
authors.affiliation: From the Departments of Interventional Radiology (G.T., M.A.T., J.G., X.B., A.G.) and Spine Surgery (J.P.S.), Strasbourg University Hospital, 1 pl. de l'Hôpital, 67091 Strasbourg, France.
authors.forename: Georgia
authors.initials: G
authors.lastname: Tsoumakidou
authors.affiliation: From the Departments of Interventional Radiology (G.T., M.A.T., J.G., X.B., A.G.) and Spine Surgery (J.P.S.), Strasbourg University Hospital, 1 pl. de l'Hôpital, 67091 Strasbourg, France.
authors.forename: Marie-Aude
authors.initials: MA
authors.lastname: Thénint
authors.affiliation: From the Departments of Interventional Radiology (G.T., M.A.T., J.G., X.B., A.G.) and Spine Surgery (J.P.S.), Strasbourg University Hospital, 1 pl. de l'Hôpital, 67091 Strasbourg, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Garnon
authors.affiliation: From the Departments of Interventional Radiology (G.T., M.A.T., J.G., X.B., A.G.) and Spine Surgery (J.P.S.), Strasbourg University Hospital, 1 pl. de l'Hôpital, 67091 Strasbourg, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Buy
authors.affiliation: From the Departments of Interventional Radiology (G.T., M.A.T., J.G., X.B., A.G.) and Spine Surgery (J.P.S.), Strasbourg University Hospital, 1 pl. de l'Hôpital, 67091 Strasbourg, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Steib
authors.affiliation: From the Departments of Interventional Radiology (G.T., M.A.T., J.G., X.B., A.G.) and Spine Surgery (J.P.S.), Strasbourg University Hospital, 1 pl. de l'Hôpital, 67091 Strasbourg, France.
authors.forename: Afshin
authors.initials: A
authors.lastname: Gangi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007834:Lasers; D008028:Light Coagulation / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D010017:Osteoma, Osteoid / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome