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Radiofrequency ablation is as safe and effective as surgical excision for spinal osteoid osteoma: a systematic review and meta-analysis

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Abstract

Background

Osteoid osteoma (OO) is a primary benign tumor that affects mainly young patients. Ten percent of all OO are located in the vertebral column. Treatment of spinal OO is challenging and there is no consensus in the literature on the best operative approach.

Purpose

The aim of this systematic review and meta-analysis was to determine safety and efficacy of radiofrequency ablation (RFA) versus surgical excision for the treatment of spinal OO.

Methods

A literature search was performed on PubMed, Web of Science, and Embase from inception up to 22 March 2022. Studies addressing surgical excision or RFA for the treatment of spinal OO were included. The main outcomes evaluated were pain before and after intervention, the treatments success rate, defined as complete pain relief with no recurrence until the last follow-up, and the number and type of complications.

Results

Thirty-one studies (749 patients) were included. For patients who underwent surgical excision, 19 studies reported a mean treatment success rate of 85.6%, while in the RFA treatment group, 18 studies reported a mean success rate of 88.6%. At last follow-up, the pooled mean difference in pain scores from baseline on a 0–10 scale was 5.8 points in the surgical excision group and 6.7 points in the RFA group. Recurrences were observed in 5.6% of the patients who underwent surgical excision and in 6.7% of the patients treated with RFA. The complication rate was 7.8% in the surgical excision group and 4.4% in the RFA group.

Conclusions

This meta-analysis found high global success rates for both surgical and RFA treatments. Both treatments were efficient in pain relief and presented a low rate of recurrences. The complication rate was low for both treatments. Compared to surgical excision, RFA is a less invasive procedure which proved to be a safe and as effective option for the treatment of spinal OO.

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References

  1. Aiba H, Hayashi K, Inatani H, Satoshi Y, Watanabe N, Sakurai H et al (2014) Conservative treatment for patients with osteoid osteoma: a case series. Anticancer Res 34(7):3721–3725

    Google Scholar 

  2. Lee EH, Shafi M, Hui JH (2006) Osteoid osteoma: a current review. J Pediatr Orthop 26(5):695–700

    Article  Google Scholar 

  3. Lorenc T, Kocoń H, Gołębiowski M (2021) Computed tomography-guided percutaneous radiofrequency and laser ablation for the treatment of osteoid osteoma—long-term follow-up from 5 to 10 years. Pol J Radiol 86:e19–e30

    Article  Google Scholar 

  4. Tepelenis K, Skandalakis GP, Papathanakos G, Kefala MA, Kitsouli A, Barbouti A et al (2021) Osteoid osteoma: an updated review of epidemiology, pathogenesis, clinical presentation, radiological features, and treatment option. In vivo (Athens, Greece) 35(4):1929–1938

    CAS  Google Scholar 

  5. Pipola V, Tedesco G, Spinnato P, Facchini G, Gala RB, Bandiera S et al (2021) Surgery versus radiofrequency ablation in the management of spinal osteoid osteomas: a spine oncology referral center comparison analysis of 138 cases. World Neurosurg 145:e298–e304

    Article  Google Scholar 

  6. Gasbarrini A, Cappuccio M, Bandiera S, Amendola L, van Urk P, Boriani S (2011) Osteoid osteoma of the mobile spine: surgical outcomes in 81 patients. Spine 36(24):2089–2093

    Article  Google Scholar 

  7. Arrigoni F, Spiliopoulos S, de Cataldo C, Reppas L, Palumbo P, Mazioti A et al (2021) A bicentric propensity score matched study comparing percutaneous computed tomography-guided radiofrequency ablation to magnetic resonance-guided focused ultrasound for the treatment of osteoid osteoma. J Vasc Interv Radiol JVIR 32(7):1044–1051

    Article  Google Scholar 

  8. Filippiadis D, Stefanou D, Mazioti A, Foti L, Tsochatzis A, Kelekis N et al (2022) Computed tomography guided radiofrequency ablation of osteoid osteoma in children: a single center’s experience. Skeletal Radiol 51(4):855–861

    Article  Google Scholar 

  9. Efthymiadis A, Tsikopoulos K, Uddin F, Kitridis D, Edwards N, Sidiropoulos K et al (2022) Which is the optimal minimally invasive treatment for osteoid osteoma of the hip? A systematic review and proportional meta-analysis. J Orthop Sci Off J Jpn Orthop Assoc 27(2):456–462

    Google Scholar 

  10. Lindquester WS, Crowley J, Hawkins CM (2020) Percutaneous thermal ablation for treatment of osteoid osteoma: a systematic review and analysis. Skeletal Radiol 49(9):1403–1411

    Article  Google Scholar 

  11. Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Commun Health 52(6):377–384

    Article  CAS  Google Scholar 

  12. Neyeloff JL, Fuchs SC, Moreira LB (2012) Meta-analyses and Forest plots using a microsoft excel spreadsheet: step-by-step guide focusing on descriptive data analysis. BMC Res Notes 5:52

    Article  Google Scholar 

  13. Laus M, Albisinni U, Alfonso C, Zappoli FA (2007) Osteoid osteoma of the cervical spine: surgical treatment or percutaneous radiofrequency coagulation? Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 16(12):2078–2082

    Article  CAS  Google Scholar 

  14. Hadjipavlou AG, Tzermiadianos MN, Kakavelakis KN, Lander P (2009) Percutaneous core excision and radiofrequency thermo-coagulation for the ablation of osteoid osteoma of the spine. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 18(3):345–351

    Article  Google Scholar 

  15. Weber MA, Sprengel SD, Omlor GW, Lehner B, Wiedenhöfer B, Kauczor HU et al (2015) Clinical long-term outcome, technical success, and cost analysis of radiofrequency ablation for the treatment of osteoblastomas and spinal osteoid osteomas in comparison to open surgical resection. Skeletal Radiol 44(7):981–993

    Article  Google Scholar 

  16. Zhang Y, Xu W, Li Z, Li Y, Yu R, Chen J (2017) Comparison of application of CT-guided radiofrequency ablation and open surgery in the treatment of osteoid osteoma of the spine. Int J Clin Exp Med 10(4):7000–7005

    Google Scholar 

  17. Yu X, Wang B, Yang S, Han S, Jiang L, Liu X et al (2019) Percutaneous radiofrequency ablation versus open surgical resection for spinal osteoid osteoma. Spine J Off J North Am Spine Soc 19(3):509–515

    Article  Google Scholar 

  18. Klass D, Marshall T, Toms A (2009) CT-guided radiofrequency ablation of spinal osteoid osteomas with concomitant perineural and epidural irrigation for neuroprotection. Eur Radiol 19(9):2238–2243

    Article  Google Scholar 

  19. Martel J, Bueno A, Nieto-Morales ML, Ortiz EJ (2009) Osteoid osteoma of the spine: CT-guided monopolar radiofrequency ablation. Eur J Radiol 71(3):564–569

    Article  Google Scholar 

  20. Vanderschueren GM, Obermann WR, Dijkstra SP, Taminiau AH, Bloem JL, van Erkel AR (2009) Radiofrequency ablation of spinal osteoid osteoma: clinical outcome. Spine 34(9):901–904

    Article  Google Scholar 

  21. Hoffmann RT, Jakobs TF, Kubisch CH, Trumm CG, Weber C, Duerr HR et al (2010) Radiofrequency ablation in the treatment of osteoid osteoma-5-year experience. Eur J Radiol 73(2):374–379

    Article  Google Scholar 

  22. Morassi LG, Kokkinis K, Evangelopoulos DS, Karargyris O, Vlachou I, Kalokairinou K et al (2014) Percutaneous radiofrequency ablation of spinal osteoid osteoma under CT guidance. Br J Radiol 87(1038):20140003

    Article  CAS  Google Scholar 

  23. Albisinni U, Facchini G, Spinnato P, Gasbarrini A, Bazzocchi A (2017) Spinal osteoid osteoma: efficacy and safety of radiofrequency ablation. Skeletal Radiol 46(8):1087–1094

    Article  Google Scholar 

  24. Faddoul J, Faddoul Y, Kobaiter-Maarrawi S, Moussa R, Rizk T, Nohra G et al (2017) Radiofrequency ablation of spinal osteoid osteoma: a prospective study. J Neurosurg Spine 26(3):313–318

    Article  Google Scholar 

  25. Nöel MA, Segura MJ, Sierre S, Francheri Wilson IA, Tello CA, Galaretto E et al (2017) Neurophysiological monitoring in radiofrequency ablation of spinal osteoid osteoma with a progressive time and temperature protocol in children. Spine Deform 5(5):351–359

    Article  Google Scholar 

  26. Wang B, Han SB, Jiang L, Yuan HS, Liu C, Zhu B et al (2017) Percutaneous radiofrequency ablation for spinal osteoid osteoma and osteoblastoma. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 26(7):1884–1892

    Article  Google Scholar 

  27. Vidoni A, Grainger M, James S (2018) Experience of neuroprotective air injection during radiofrequency ablation (RFA) of spinal osteoid osteoma. Eur Radiol 28(10):4146–4150

    Article  Google Scholar 

  28. Tomasian A, Jennings JW (2018) Percutaneous radiofrequency ablation of spinal osteoid osteomas using a targeted navigational bipolar electrode system. AJNR Am J Neuroradiol 39(12):2385–2388

    Article  CAS  Google Scholar 

  29. Beyer T, van Rijswijk CSP, Villagrán JM, Rehnitz C, Muto M, von Falck C et al (2019) European multicentre study on technical success and long-term clinical outcome of radiofrequency ablation for the treatment of spinal osteoid osteomas and osteoblastomas. Neuroradiology 61(8):935–942

    Article  Google Scholar 

  30. Kirwan EO, Hutton PA, Pozo JL, Ransford AO (1984) Osteoid osteoma and benign osteoblastoma of the spine. Clinical presentation and treatment. J Bone Joint Surg Br Vol 66(1):21–26

    Article  CAS  Google Scholar 

  31. Maiuri F, Signorelli C, Lavano A, Gambardella A, Simari R, D’Andrea F (1986) Osteoid osteomas of the spine. Surg Neurol 25(4):375–380

    Article  CAS  Google Scholar 

  32. Raskas DS, Graziano GP, Herzenberg JE, Heidelberger KP, Hensinger RN (1992) Osteoid osteoma and osteoblastoma of the spine. J Spinal Disord 5(2):204–211

    Article  CAS  Google Scholar 

  33. Ozaki T, Liljenqvist U, Hillmann A, Halm H, Lindner N, Gosheger G et al (2002) Osteoid osteoma and osteoblastoma of the spine: experiences with 22 patients. Clin Orthop Relat Res 397:394–402

    Article  Google Scholar 

  34. Aydinli U, Ozturk C, Ersozlu S, Filiz G (2003) Results of surgical treatment of osteoid osteoma of the spine. Acta Orthop Belg 69(4):350–354

    Google Scholar 

  35. Zileli M, Cagli S, Basdemir G, Ersahin Y (2003) Osteoid osteomas and osteoblastomas of the spine. Neurosurg Focus 15(5):E5

    Article  Google Scholar 

  36. Hempfing A, Hoffend J, Bitsch RG, Bernd L (2007) The indication for gamma probe-guided surgery of spinal osteoid osteomas. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 16(10):1668–1672

    Article  CAS  Google Scholar 

  37. Burn SC, Ansorge O, Zeller R, Drake JM (2009) Management of osteoblastoma and osteoid osteoma of the spine in childhood. J Neurosurg Pediatr 4(5):434–438

    Article  Google Scholar 

  38. Pourfeizi HH, Tabrizi A, Bazavar M, Sales JG (2014) Clinical findings and results of surgical resection of thoracolumbar osteoid osteoma. Asian Spine J 8(2):150–155

    Article  Google Scholar 

  39. Etemadifar MR, Hadi A (2015) Clinical findings and results of surgical resection in 19 cases of spinal osteoid osteoma. Asian Spine J 9(3):386–393

    Article  Google Scholar 

  40. Quraishi NA, Boriani S, Sabou S, Varga PP, Luzzati A, Gokaslan ZL et al (2017) A multicenter cohort study of spinal osteoid osteomas: results of surgical treatment and analysis of local recurrence. Spine J Off J North Am Spine Soc 17(3):401–408

    Article  Google Scholar 

  41. Mallepally AR, Mahajan R, Pacha S, Rustagi T, Marathe N, Chhabra HS (2020) Spinal osteoid osteoma: surgical resection and review of literature. Surg Neurol Int 11:308

    Article  Google Scholar 

  42. Acanfora C, Grassi E, Giacobbe G, Ferrante M, Granata V, Barile A et al (2022) Post-procedural follow-up of the interventional radiology’s management of osteoid osteomas and osteoblastomas. J Clin Med. https://doi.org/10.3390/jcm11071987

    Article  Google Scholar 

  43. Sagoo NS, Haider AS, Chen AL, Vannabouathong C, Larsen K, Sharma R et al (2022) Radiofrequency ablation for spinal osteoid osteoma: A systematic review of safety and treatment outcomes. Surg Oncol 41:101747

    Article  Google Scholar 

  44. Singh DK, Katyan A, Kumar N, Nigam K, Jaiswal B, Misra RN (2020) CT-guided radiofrequency ablation of osteoid osteoma: established concepts and new ideas. Br J Radiol 93(1114):20200266

    Article  Google Scholar 

  45. Chen YL, Jiang WY, Ma WH (2020) Osteoid osteoma: lower back pain combined with scoliosis. J Int Med Res 48(2):300060520903873

    Article  Google Scholar 

  46. Pettine KA, Klassen RA (1986) Osteoid-osteoma and osteoblastoma of the spine. J Bone Joint Surg Am 68(3):354–361

    Article  CAS  Google Scholar 

  47. Singh DK, Kumar N, Rustagi A, Jalan D, Krishna LG, Sharma A (2022) Percutaneous CT-guided radiofrequency ablation of osteoid osteoma: Potential Pitfalls and complications and how to avoid them. J Clin Orthop Trauma 28:101869

    Article  Google Scholar 

  48. Yuce G, Aytekin N, Eren S, Genç B, Ateş ÖF, Canyiğit M (2020) Is radiofrequency ablation safe and effective in treating osteoid osteomas? A prospective single-center study with atypical cases. J Orthop Surg (Hong Kong) 28(3):2309499020960555

    Article  Google Scholar 

  49. Reis J, Chang Y, Sharma AK (2020) Radiofrequency ablation vs microwave ablation for osteoid osteomas: long-term results. Skeletal Radiol 49(12):1995–2000

    Article  Google Scholar 

  50. Geiger D, Napoli A, Conchiglia A, Gregori LM, Arrigoni F, Bazzocchi A et al (2014) MR-guided focused ultrasound (MRgFUS) ablation for the treatment of nonspinal osteoid osteoma: a prospective multicenter evaluation. J Bone Joint Surg Am 96(9):743–751

    Article  CAS  Google Scholar 

  51. Meng L, Zhang X, Xu R, Wu B, Zhang X, Wei Y et al (2021) A preliminary comparative study of percutaneous CT-guided cryoablation with surgical resection for osteoid osteoma. PeerJ 9:e10724

    Article  Google Scholar 

  52. Shanmugasundaram S, Nadkarni S, Kumar A, Shukla PA (2021) Percutaneous ablative therapies for the management of osteoid osteomas: a systematic review and meta-analysis. Cardiovasc Intervent Radiol 44(5):739–749

    Article  Google Scholar 

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Funding

No funding was received for conducting this study. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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Authors and Affiliations

  1. Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

    Alessandro Sangiorgio, Lorenzo Massimo Oldrini, Christian Candrian & Giuseppe Filardo

  2. Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland

    Christian Candrian & Giuseppe Filardo

  3. Clinica Ortopedica e Traumatologica III, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Costantino Errani

  4. Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Giuseppe Filardo

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  1. Alessandro Sangiorgio
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Correspondence to Alessandro Sangiorgio.

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Sangiorgio, A., Oldrini, L.M., Candrian, C. et al. Radiofrequency ablation is as safe and effective as surgical excision for spinal osteoid osteoma: a systematic review and meta-analysis. Eur Spine J 32, 210–220 (2023). https://doi.org/10.1007/s00586-022-07411-8

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