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Neurophysiological Monitoring in Radiofrequency Ablation of Spinal Osteoid Osteoma With a Progressive Time and Temperature Protocol in Children

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Abstract

Study Design

Retrospective. Level IV Evidence.

Objective

To assess the utility of intraoperative neurophysiological monitoring (IONM) to detect and eventually prevent impending neurovascular damage during computed tomography (CT)-guided radiofrequency ablation (RFA) of spinal osteoid osteoma (OO) in children.

Summary and Background Data

To our knowledge, this is the first case series of spinal OO in pediatric patients treated at a single center employing IONM during RFA.

Methods

This is a retrospective study of seven consecutive patients (3 girls and 4 boys, mean age: 9 years 4 months) with imaging and clinical signs compatible with spinal OO who underwent CT-guided RFA, under general anesthesia, and IONM in a single center between 2011 and 2015. Before the RFA procedure, a CT-guided percutaneous biopsy of the nidus was performed in the same setting. RFA was divided into four cycles of increasing time and temperature and performed under IONM in every patient.

Results

Two patients had lesions located in the thoracic spine and five patients had lumbar involvement. The RFA technical and clinical success was 85.7%. Six patients presented with reversible neurophysiological changes either during biopsy needle positioning or RFA cycles. In the remaining case, as IONM changes did not improve after several minutes of neuroprotective hypertension, the procedure was interrupted. Neither neurologic nor vascular complications were observed after RFA treatment. In only one biopsy sample, OO was confirmed by histopathologic studies.

Conclusion

CT-guided RFA is an accepted minimally invasive technique for the treatment of spinal OO in children. IONM may be a helpful tool that requires minimal additional time and provides feedback on the state of the spinal cord and nerves at risk during the procedure. We promote the use of IONM during these procedures to detect and possibly prevent impending neurologic damage.

Level of Evidence

Level IV.

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Author information

Authors and Affiliations

  1. Spine Surgery Service, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Buenos Aires, Argentina

    Mariano A. Nöel MD, Ida A. Francheri Wilson MD, Carlos A. Tello MD, PhD, Eduardo Galaretto MD, Rodrigo G. Remondino MD, Ernesto S. Bersusky MD & Lucas Piantoni MD

  2. Neurophisiology Unit, Neurology, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Buenos Aires, Argentina

    Martin J. Segura MD, PhD & María E. Talarico MD

  3. Interventional Radiology Department, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Buenos Aires, Argentina

    Sergio Sierre MD

Authors
  1. Mariano A. Nöel MD
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  2. Martin J. Segura MD, PhD
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  3. Sergio Sierre MD
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  4. Ida A. Francheri Wilson MD
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  5. Carlos A. Tello MD, PhD
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  6. Eduardo Galaretto MD
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  7. Rodrigo G. Remondino MD
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  8. María E. Talarico MD
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  9. Ernesto S. Bersusky MD
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  10. Lucas Piantoni MD
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Corresponding author

Correspondence to Mariano A. Nöel MD.

Additional information

Author disclosures

MAN (none); MJS (none); SS (none); WIAF (none); CAT (grants from Biomet, during the conduct of the study); EG (none); RGR (none); MET (none); ESB (none); LP (none).

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Nöel, M.A., Segura, M.J., Sierre, S. et al. Neurophysiological Monitoring in Radiofrequency Ablation of Spinal Osteoid Osteoma With a Progressive Time and Temperature Protocol in Children. Spine Deform 5, 351–359 (2017). https://doi.org/10.1016/j.jspd.2017.03.001

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  • DOI: https://doi.org/10.1016/j.jspd.2017.03.001

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