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Radiofrequenzablation bei Osteoidosteomen der Wirbelsäule

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Radiofrequency ablation in spinal osteoid osteoma

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Zusammenfassung

Das erstmals 1935 von Jaffe beschriebene Osteoidosteom stellt eine gutartige knöcherne Neoplasie mit Hauptmanifestation in den Diaphysen langer Röhrenknochen dar. Zehn Prozent der Osteoidosteome manifestieren sich in der Wirbelsäule, hauptsächlich in den dorsalen knöchernen Strukturen der LWS und BWS. Therapiebedarf besteht wegen belastungsunabhängiger nächtlicher Knochenschmerzen, die auf Grund der ursächlichen Prostaglandinproduktion im Nidus gut auf nichtsteroidale Antirheumatika ansprechen. Die Diagnosesicherung erfolgt mittels Dünnschicht-CT, MRT und Tc-Skelettszintigraphie. Bei typischer Klinik und Bildgebung kann auf eine bioptische Befundsicherung meist verzichtet werden. Während sich die Radiofrequenzablation als Goldstandard bei der Therapie des Osteoidosteoms der Extremitäten etabliert hat, zeigt das Verfahren im Bereich der Wirbelsäule Einschränkungen wegen des Risikos einer thermischen Schädigung benachbarter neurovaskulärer Strukturen. In letzter Zeit erweitern technische Weiterentwicklungen der Radiofrequenzablation das Indikationsspektrum erheblich, sodass auf eine operative Exzision von Osteoidosteomen auch an der Wirbelsäule zunehmend verzichtet werden kann.

Abstract

Osteoid osteoma was first described by Jaffe in 1935 as a benign bone neoplasm mainly located in the diaphyseal areas of long bones: 10% are located in the spine, mainly in the lumbar and thoracic posterior elements. Therapy is required due to nocturnal pain independent of the physical load and responds especially well to anti-inflammatory drugs due to the excessive production of prostaglandins in the nidus. Diagnosis is confirmed by multi-slice computed tomography (CT), magnetic resonance imaging (MRI) and skeletal scintigraphy scans. In cases with typical symptoms and imaging, open biopsies are rarely needed. Although CT-guided radiofrequency ablation is accepted as the gold standard treatment option for osteoid osteoma in the extremities, this technique is limited in spinal applications due to the risk of thermal damage to adjacent neurovascular structures. Technical advances in the administration of radiofrequency ablation have, however, resulted in new and expanded indications in the spine so that the necessity for open surgical excision of spinal osteoid osteoma is becoming less.

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  1. Department Orthopädie, Unfallchirurgie und Paraplegiologie, Stiftung Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland

    G.W. Omlor, B. Lehner, B. Wiedenhöfer, C. Deininger, M.A. Weber & C. Rehnitz

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  1. G.W. Omlor
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  2. B. Lehner
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  3. B. Wiedenhöfer
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  4. C. Deininger
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  5. M.A. Weber
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  6. C. Rehnitz
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Correspondence to G.W. Omlor.

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Omlor, G., Lehner, B., Wiedenhöfer, B. et al. Radiofrequenzablation bei Osteoidosteomen der Wirbelsäule. Orthopäde 41, 618–622 (2012). https://doi.org/10.1007/s00132-012-1907-x

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