Osteoid osteoma of the spine treated with percutaneous computed tomography-guided thermocoagulation

Study Design. Two cases are reported in which an osteoid osteoma of the lum bar spine was treated with CT-guided thermocoagulation. Objectives, To review an alternative and minimally invasive treatment for s pinal osteoid osteomas. Summary of Background Data. Surgical resection of a spinal osteoid osteoma can, depending on the location, be a formidable undertaking. Bone scintigra phy can be helpful in intraoperative identification. More recently, resecti on through a computed tomography-guided drill hole was found to minimize ex posure. Using a thermocoagulation probe, as has been used in osteoid osteom a of the extremities, may be technically easier and cause less morbidity. Method. With the patient under general anesthesia, a bone biopsy cannula wa s introduced into the center of the osteoid osteoma. Material was subjected to histologic examination. A thermocoagulation probe was then inserted and heated to 90 C for 4 minutes. The two patients were kept overnight for obs ervation. Results. Both patients had complete pain relief and no evidence of recurren ce after 2 years' follow-up. There were no complications. Scoliosis resolve d in one patient and persisted in the other. Conclusion. Percutaneous computed tomography-guided thermocoagulation is a minimally invasive and technically straightforward method to achieve ablati on of a spinal osteoid osteoma. No complications were encountered in these two patients. Future research should focus on the safety of thermocoagulati on, especially cephalad to the level of the conus medullaris.