Osteoid osteoma


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benign bone tumor, percutaneous drilling, CT localization, Bone scan

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Osteoid osteoma

  1. 1. Osteoid Osteoma Vinod Naneria Girish Yeotikar Arjun Wadhwani Choithram Hospital & Research Centre, Indore India
  2. 2. Osteoid Osteoma • Benign neoplasm most often seen in young males. • Found in the first three decades of life, occasionally reported in older patients. • Incidence is 13.5% in all benign tumors of bones. • M/F ratio is 4:1. • Bergstrand -first described in 1930. • Jaffe in 1935 - first to recognize it as a unique entity.
  3. 3. Osteoid Osteoma • Any bone can be involved, • There is a predilection for the lower extremity, with half the cases involving the femur or tibia. • The tumor may be found in cortical or cancellous bone, producing a distinct x-ray appearance of cortical sclerosis. • 5% of tumors are subperiosteal.
  4. 4. Osteoid Osteoma • Multicentric foci have been reported. • No malignant change has ever been documented. • The typical patient has pain that is worse at night and relieved by aspirin.
  5. 5. Osteoid Osteoma • When the lesion is near a joint, swelling, stiffness, and contracture may occur. • When in a vertebra, scoliosis may occur. • Occasionally, osteoid osteoma occurs with minimal pain. • In children, overgrowth and angular deformities may occur.
  6. 6. Osteoid Osteoma - Diagnosis • Routine roentgenograms often are diagnostic, but bone scans or CT are often required to localize the lesion accurately.
  7. 7. Osteoid Osteoma • CT may detect the nidus, whereas roentgenograms show only sclerosis.
  8. 8. Osteoid Osteoma - CT • CT is more accurate than MRI. • CT helped in confirming the diagnosis of osteoid osteoma in 74% of cases. • Szendroi et al reported accuracies of about 66% in the diagnosis of intra-articular lesions and 90% in extra-articular lesions. • To date, CT scanning is the primary investigational tool for the definitive diagnosis of osteoid osteoma.
  9. 9. Osteoid Osteoma – Bone scan • To date, no negative bone-scan findings have been reported in patients with osteoid osteoma. • Bone scanning is currently the most accurate means of localizing the tumour. • Wells et al noted that the sensitivity of skeletal bone scan for osteoid osteoma is 100%.
  10. 10. Osteoid Osteoma – Bone scan • A bone scan is helpful in detecting the "doubledensity sign," which is a focal area of increased activity with a second smaller area of increased uptake superimposed on it, is said to be diagnostic of osteoid osteoma.
  11. 11. Osteoid Osteoma - MRI • MRI has not been useful in the diagnosis of osteoid osteoma. • MRI is reserved for equivocal cases because it can suggest the diagnosis of osteoid osteoma. • MRI interpretation may result in errors in diagnosis, most often confusion with malignancies.
  12. 12. Natural History • The literature suggests a history of resolving pain and healing of the lesions. • The course of this disease is unpredictable and protracted, with intervals of resolution of pain that sometimes last 6-15 years.
  13. 13. Natural History - Stages • Atar et al (1992) described 2 stages of the disease. • The first is an acutely painful stage that lasts 18-36 months, during which patients require steady use of analgesics. • The second is the recovery stage, which includes healing of the nidus and which usually takes 3-7 years.
  14. 14. Natural History • Barei et al noted that healing involves ossification of the untreated nidus, which cannot be readily distinguished from surrounding bone and which resembles a localized zone of cortical hypertrophy.
  15. 15. Osteoid Osteoma - Tx • En bloc resection • The entire nidus must be removed. • Block resection of the nidus. • Unroofing and curettage • An alternative method - shave the reactive bone with a sharp osteotome until the nidus is encountered, then curettage of the exposed nidus.
  16. 16. Osteoid Osteoma - Tx • Intraoperative localization of the nidus is possible with preoperatively injected technetium-labeled methylene diphosphonate and a sterile, wrapped Geiger counter.
  17. 17. Osteoid Osteoma - Tx • Excision of the osteoid osteoma nidus using CT–assisted localization, a Kirschner wire inserted into the nidus, and a biopsy punch inserted over the Kirschner wire into the bone. • They recommend using a trephine 2 mm larger than the lesion for complete removal. • Recurrence after apparently complete excision has been reported but is rare.
  18. 18. • A CT guided needle was passed to localize the lesion. • Through an anterior "Hernia" approach the lesion was approached and excised. • The Follow-up CT Scanning done to reveal complete removal of lesion. • A biopsy confirmed it later.
  19. 19. Post op – after drilling
  20. 20. CT – Guided Drilling • • • • • • • • OPD procedure, Localization of the nidus in CT Scan, Local anesthesia, K-wire passed into nidus, Transferred to OT, Short GA, Drilling of the nidus by a cannulated drill, Complete relief of pain.
  21. 21. Referrence CT-guided percutaneous drilling is a safe and reliable method of treating osteoid osteomas Edgard Eduard Engel, Nelson Fabrício Gava, Marcello Henrique Nogueira-Barbosa, Filipe Almeida Botter • doi:10.1186/2193-1801-2-34 Engel et al.: CT-guided percutaneous drilling is a safe and reliable method of treating osteoid osteomas. SpringerPlus 2013 2:34.
  22. 22. Summary • Traditional open surgical treatment consists of en bloc resection and unroofing and curettage, which is the treatment of choice. The rate of primary cure is approximately 100%. • Disadvantages include perioperative morbidity, extended hospital stay, perioperative fractures, a need for bone grafts or internal fixation, periarticular stiffness, and delayed functional recovery. The recurrence rate is 9-28%.
  23. 23. Summary • Minimally invasive surgical treatments include radionuclide-guided excision, CT-guided percutaneous excision, percutaneous laser photocoagulation, percutaneous radiofrequency coagulation, and computer-assisted surgery. • Success rates can reach approximately 100%. Disadvantages include incomplete resection in 35% of patients, persistence of symptoms in 23%, and recurrence in 12%.
  24. 24. DISCLAIMER • Information contained and transmitted by this presentation is based on personal experience and collection of cases at Choithram Hospital & Research centre, Indore, India, during last 34 years. • It is intended for use only by the students of orthopaedic surgery. • Views and opinion expressed in this presentation are personal. • Depending upon the x-rays and clinical presentations viewers can make their own opinion. • For any confusion please contact the sole author for clarification. • Every body is allowed to copy or download and use the material best suited to him. I am not responsible for any controversies arise out of this presentation. • For any correction or suggestion please contact • naneria@yahoo.com