PERCUTANEOUS RADIOFREQUENCY COAGULATION OF OSTEOID OSTEOMA COMPARED WITH OPERATIVE TREATMENT

Osteoid osteoma, a benign bone tumor, has traditionally been treated w ith operative excision. A recently developed method for percutaneous a blation of the tumor has been proposed as an alternative to operative treatment. The relative outcomes of the two approaches to treatment ha ve not previously been compared, to our knowledge. The rates of recurr ence and of persistent symptoms were compared in a consecutive series of eighty-seven patients who were managed with operative excision and thirty-eight patients who were managed with percutaneous ablation with radiofrequency. Patients who had a spinal lesion were excluded, The m inimum duration of follow-up was two years. There was a recurrence, de fined as the need for subsequent intervention, after operative treatme nt in six (9 per cent) of sixty-eight patients who had been managed fo r a primary lesion and in two of nineteen who had been managed for a r ecurrent lesion. The average length of the hospital stay was 4.7 days for the patients who had a primary lesion and 5.1 days for those who h ad a recurrent lesion, There was a recurrence after percutaneous treat ment in four (12 per cent) of thirty-three patients who had been manag ed for a primary lesion and in none of five who had been managed for a recurrent lesion. The average length of the hospital stay was 0.2 day for these thirty-eight patients. With the numbers available, we could detect no significant difference between the two treatments with rega rd to the rate of recurrence. The rate of persistent symptoms (that is , symptoms that did not necessitate additional treatment) was greater than the rate of recurrence, According to responses to a questionnaire , eight (30 per cent) of twenty-seven patients had persistent symptoms after operative treatment and six (23 per cent) of twenty-six patient s had persistent symptoms after percutaneous treatment with radiofrequ ency, Two patients had complications after operative excision, necessi tating a total of five additional operations. There were no complicati ons associated with the percutaneous method. The results of the presen t study suggest that percutaneous ablation with radiofrequency is esse ntially equivalent to operative excision for the treatment of an osteo id osteoma in an extremity The percutaneous method is preferred for th e treatment of extraspinal osteoid osteoma because it generally does n ot necessitate hospitalization, it has not been associated with compli cations, and it is associated with a rapid convalescence.