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Study Design: Clinically based systematic review., Objective: To determine the role of (A) medical treatment and (B) interventional radiology as either adjuvant or stand-alone treatment in primary benign bone tumors of the spine., Methods: A multidisciplinary panel of spine surgeons, radiation oncologists, and medical oncologists elaborated specific focused questions regarding aneurysmal bone cyst, giant cell tumor, and osteoid osteoma. Denosumab, bisphosphonate, interferon, bone marrow aspirate, doxycycline, thermal ablation, and selective arterial embolization were identified as areas of interest for the article. A systematic review was performed through MEDLINE and EMBASE. Recommendations based on the literature review and clinical expertise were issued using the GRADE system., Results: The overall quality of the literature is very low with few multicenter prospective studies. For giant cell tumor, combination with Denosumab identified 14 pertinent articles with four multicenter prospective studies. Nine studies were found on bisphosphonates and six for selective arterial embolization. The search on aneurysmal bone cyst and selective arterial embolization revealed 12 articles. Combination with Denosumab, Doxycycline, and bone marrow aspirate identified four, two, and three relevant articles respectively. Eleven focused articles were selected on the role of thermal ablation in osteoid osteoma., Conclusion: Alternative and adjuvant therapy for primary benign bone tumors have emerged. Their ability to complement or replace surgery is now being scrutinized and they may impact significantly the algorithm of treatment of these tumors. Most of the data are still emerging and further research is desirable. Close collaboration between the different specialists managing these pathologies is crucial., Level of Evidence: N/A.

The incidence of both benign and malignant bone tumors arising in the hand is relatively low in comparison with other locations. Although the overwhelming majority of these tumors are benign, even benign tumors can be locally destructive and compromise hand function. Intralesional tumor excision is the most appropriate surgical intervention for many benign bone tumors of the hand; however, destructive or malignant tumors may require wide local excision or even amputation to achieve complete tumor eradication. The purpose of this review article is to provide an overview of the pertinent benign and malignant bone tumors that may be encountered by hand surgeons. Clinical presentation, radiographic features, recommended workup, and available treatment options are all reviewed.

Background: We aimed to evaluate the effectiveness of image-guided laser ablation for the treatment of osteoid osteomas in pediatric patients., Methods: From June 1994 to June 2006, 68 patients aged 3 to 18 years (mean age, 12.1 +/- 4.2 years) with a diagnosis of osteoid osteoma underwent laser ablation in our department. Among them, 3 patients had prior unsuccessful attempt of surgical resection. Procedures were performed under spinal or general anesthesia with combined computed tomographic and fluoroscopic guidance. An 18-gauge needle was placed in the nidus after bone drilling when required, and an optical fiber was inserted through it. An average energy of 1200 J was delivered using an infrared diode laser generator. Patients were discharged the next day and followed up with assessment of pain, medication intakes, and potential complications. Clinical success was defined by complete pain relief without need for medication intake., Results: Technical success was achieved in all but 1 of our first patients, which was subsequently treated by percutaneous resection. Overall clinical success was 98%. Primary clinical success was obtained in 60 patients (88%). In 7 patients, recurrence of symptoms at 4 to 27 months from the initial procedure was managed by repeat laser ablation, resulting in secondary success (10%). No complications related to the procedure were observed. Follow-up ranged 16 to 146 months (mean, 83 months)., Conclusions: Currently, image-guided laser ablation is a safe and effective procedure that can be proposed as the mainstay treatment of osteoid osteomas in pediatrics., Level of Evidence: Therapeutic case series study level IV.

Study Design: Two cases are reported in which an osteoid osteoma of the lumbar spine was treated with CT-guided thermocoagulation., Objectives: To review an alternative and minimally invasive treatment for spinal osteoid osteomas., Summary of Background Data: Surgical resection of a spinal osteoid osteoma can, depending on the location, be a formidable undertaking. Bone scintigraphy can be helpful in intraoperative identification. More recently, resection through a computed tomography-guided drill hole was found to minimize exposure. Using a thermocoagulation probe, as has been used in osteoid osteoma of the extremities, may be technically easier and cause less morbidity., Method: With the patient under general anesthesia, a bone biopsy cannula was 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 observation., Results: Both patients had complete pain relief and no evidence of recurrence after 2 years' follow-up. There were no complications. Scoliosis resolved in one patient and persisted in the other., Conclusion: Percutaneous computed tomography-guided thermocoagulation is a minimally invasive and technically straightforward method to achieve ablation of a spinal osteoid osteoma. No complications were encountered in these two patients. Future research should focus on the safety of thermocoagulation, especially cephalad to the level of the conus medullaris.

Benign tumors of the cervical spine are relatively infrequent but have a number of common characteristics that aid in the evaluation and treatment of these lesions. The tumors are most common in the first and second decades of life, presenting as pain, neck stiffness and torticollis. In approximately 70%, the lesions are visible on plain roentgenograms and the remainder are well visualized on bone scan and computed tomographic scan. The majority are present in the posterior elements and may be treated adequately with excisional biopsy by curettage. Stage 3 lesions are best treated by marginal excisional techniques and may require adjunctive techniques such as embolization or radiation therapy. The location of the lesion and extent of excision determine the necessity for fusion.