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Magnetic resonance-guided focused ultrasound (MRgFUS) is a noninvasive, incisionless, radiation-free technology used to ablate tissue deep within the body. This technique has gained increased popularity following FDA approval for treatment of pain related to bone metastases and limited approval for treatment of osteoid osteoma. MRgFUS delivers superior visualization of soft tissue targets in unlimited imaging planes and precision in targeting and delivery of thermal dose which is all provided during real-time monitoring using MR thermometry. This paper provides an overview of the common musculoskeletal applications of MRgFUS along with updates on clinical outcomes and discussion of future applications.

Osteoid osteoma is a benign bone-forming tumor with characteristic clinical and imaging features. Clinically, patients present with pain at the site of the tumor, worsening at night and relieved by nonsteroidal anti-inflammatory drugs. The typical imaging features of osteoid osteoma include a round or oval intracortical radiolucent lesion with surrounding cortical thickening and reactive sclerosis. However, intra-articular osteoid osteoma often has imaging and clinical features that deviate from those of osteoid osteoma, which may result in delayed diagnosis. We report a case of intra-articular osteoid osteoma in a 20-year-old woman with a history of ankle pain. The variant clinical and imaging characteristics of intra-articular osteoid osteoma and the important considerations for the treatment of patients with this condition are briefly discussed.

Background: Magnetic resonance imaging (MRI), which does not involve ionizing radiation, is the preferred imaging modality for diagnosing osteoid osteoma (OO), an ailment more common in children and young adults. Purpose: This study aims to perform a literature review and delineate the MRI findings of OO lesions in patients exhibiting varying radiological features across different regions. Materials and methods: A retrospective study included 63 patients diagnosed with OO through MRI, assessed independently by two blinded radiologists using both standard and dynamic contrast‐enhanced MRI techniques. After excluding 7 patients with prior biopsy, surgery, or RFA, the study included 56 patients with 57 lesions. Results: Of 57 lesions evaluated, 50 were in long, and 7 in flat bones. One patient presented with two separate nidi within the intertrochanteric region. Most of the lesions, 49 (86%), were extra‐articular, while 8 (14%) were intra‐articular. The nidus was intracortical in 45 (78.9%) patients, intramedullary in 5 (8.8%), subperiosteal in 5 (8.8%), and endosteal in 2 (3.5%). Average nidus diameter was 7.02 ± 2.64 mm (3–12.6 mm). Central nidal calcification was present in 68.4% (n = 39) cases. Contrast enhancement was intense at 90.5%, moderate at 9.5%. Reactive sclerosis around the nidus was severe (50.9%), moderate (22.8%), and mild (26.3%). Bone marrow edema was severe (70.2%), moderate (14.0%), and mild (15.8%). Soft tissue edema was identified in 77.2% of all lesions. Conclusion: To minimize delays in diagnosis and treatment, radiologists should become acquainted with the typical OO MRI findings and the atypical MRI findings that might be mistaken for other conditions. [ABSTRACT FROM AUTHOR]

Osteoid osteomas are benign bone tumors characterized by severe localized pain, often challenging the daily lives of young patients. While these tumors are typically solitary, rare cases of multiple osteoid osteomas have been reported. This research paper presents a case series of 2 young patients with multiple osteoid osteomas, highlighting their clinical presentation, diagnostic workup, treatment with cryoablation, and follow-up. The paper emphasizes the effectiveness of cryoablation as a minimally invasive treatment option for these challenging cases.

Osteoid Osteoma (OO) is a frequent benign bone tumor that commonly affects males between 5 and 25. It usually arises from appendicular skeleton involving typically femur and tibia. OOs arising from small bones of hands and feet are very uncommon and metatarsal lesions account for only 1.7%.We report a case of a 20 year-old boy with a long history of nocturnal left foot pain with a good clinical response to assumption of salicylates or nonsteroidal anti-inflammatory drugs (NSAIDs). Plain radiograph of his left showed unconclusive results. Therefore, he underwent a contrast enhanced CT (CECT) scan with multiplanar reconstruction (MPR) that showed a bony lesion in the left third metatarsal bone that was compatible with a nidus even in absence of clear peri-nidal sclerosis. Therefore, other ancillary techniques such as MRI and bone scintigraphy were performed. Conclusive diagnosis was OO of third left metatarsal bone. Our patient underwent a mini-invasive treatment with radiofrequency (RF) ablation. After recovery, our patient had no post-operative complications and showed optimal clinical conditions with complete remission of left foot pain and no change or impairment in walking.In this essay, we discuss key imaging findings of OO of small bones and its treatment with radiofrequency ablation. We describe method of execution and illustrate advantages of this mini-invasive technique. We also perform a review of the literature.

Osteoid osteoma (OO), a benign bone-forming tumor estimated to account for 3% of all primary bone tumors, rarely occurs in the finger. This case report presents an unusual instance of osteoid osteoma in the finger of a 15-year-old male patient. The lesion was discovered following an initial patient visit for left middle finger pain and swelling for one year without any identifiable injuries.

Osteoid Osteoma (OO) is a common primary bone tumor that often presents with night pain in younger orthopedic patients. Although typically extra-articular, intra-articular presentations may be difficult to diagnose. While magnetic resonance imaging (MRI) provides excellent detailed imaging of the articular surface, it has been reported to lead to occasional misdiagnosis given limitations in spatial resolution, particularly for smaller lesions. Computed tomography (CT) remains the gold standard imaging modality for OO. The treatment for osteoid osteoma consists of medical management, minimally invasive image guided techniques, and surgical resection in order of most conservative to most aggressive. We present the case of a 31-year-old male with persistent posterolateral knee pain after subchondroplasty. CT demonstrated an OO in the posterior tibial plateau. The patient was successfully treated with CT-guided percutaneous radiofrequency ablation with complete resolution of symptoms. We also provide a brief literature review of the diagnosis and treatment of OO to help heighten the awareness of this sometimes inconspicuous diagnosis.

The aim of the current study was to evaluate the feasibility and effectiveness of CT-guided microwave ablation (MWA) in the treatment of osteoid osteomas (OO). Data from 59 consecutive patients who underwent percutaneous CT-MWA for OO treatment were examined in the current retrospective study. The period of this study spanned from January 2021 to May 2023 at a single institution. The study involved an evaluation of clinical and radiological characteristics, procedural data, Visual Analog Scale (VAS) pain scores, complication incidences, as well as clinical and technical success rates. Statistical analyses were performed by using the Wilcoxon test with Bonferroni correction, Friedman, Spearman, Mann–Whitney U test. 59 patients with an average age of 17.31 ± 8.53 years underwent CT-guided MWA for the treatment of OO. The procedure demonstrated a high success rate, with 96.6% of cases achieving both technical and clinical success. However, recurrence was observed in two patients (3.4%) at the three-month follow-up. These cases were successfully managed with a second MWA procedure. The median VAS pain scores reported by the patients was significantly improved post-procedure: from 8.64 ± 1.14 before treatment to 0.63 ± 0.98 in the first month, 0.41 ± 1.02 in the third month, and 0.15 ± 0.45 in the sixth month. Only one patient (1.7%) experienced a minor complication; no major complications were recorded in this study. CT-guided percutaneous MWA is a minimally invasive and a highly effective and safe approach for the treatment of OO. [ABSTRACT FROM AUTHOR]

Osteoblastoma and osteoid osteoma are rare benign bone tumours, sometimes considered variations of the same pathologic process. However, they differ in location, incidence, age group, and size. The gold standard treatment is surgical excision for osteoblastoma and radiofrequency ablation for both. Minimally invasive techniques, including radiofrequency ablation, microwave ablations, cryoablation, ultrasound ablation, and laser ablation, are increasingly used. This meta-analysis aimed to review current treatments, focusing on minimally invasive methods versus traditional surgical excision. A data comparison of 17 original articles from the PubMed database (2014-2024) was conducted, examining treatment methods, patient numbers, success rates, pre/post-operative pain scores, and complication rates. New ablation methods achieve similar clinical results to traditional surgery for treating osteoid osteoma and osteoblastoma while minimizing invasiveness. Most procedures have technical success rates near 100%. Both invasive and non-invasive methods significantly reduce preoperative pain. Classical surgery has higher minor complication rates compared to minimally invasive treatments. Among ablation techniques, magnetic resonance guided focused ultrasound surgery is the least invasive, avoiding radiation and antibiotic-related complications. However, in ablation methods caution is needed to prevent thermal damage to nearby joints and nerves. Protective methods, such as skin protection, hydrodissection, gas dissection, and intraoperative neurostimulation, are recommended. New ablation methods provide less invasive alternatives to surgery, with high clinical and technical success rates and lower complication rates. Among these, magnetic resonance guided focused ultrasound surgery is the least invasive and most promising, though more clinical data is needed due to its recent development. [ABSTRACT FROM AUTHOR]

Key Clinical Message: If you encounter an unexplained case of bone marrow edema in a young patient, consider the possibility of osteoid osteoma (OO). Even in the presence of a nidus near vital structures, RFA can safely be used to treat OO. [ABSTRACT FROM AUTHOR]

Objective Percutaneous CT‐guided radiofrequency ablation (CT‐RFA) is a widely accepted procedure for treatment of osteoid osteomas. However, the application of CT‐RFA was restricted as a result of some drawbacks, such as radiation exposure, and inconvenience in general anesthesia. The primary aim of this study is to evaluate the safety and efficacy of intra‐operative TiRobot‐assisted percutaneous RFA of osteoid osteomas. Methods We retrospectively reviewed 21 medical files of patients who were treated with percutaneous RFA of osteoid osteomas guided by the TiRobot system in our institution between March 2021 and April 2022. The three‐dimensional images obtained by a 3D C‐arm intra‐operatively were sent to the TiRobot system. The puncture point and trajectory were designed. Then the guide pin was positioned to the lesion with the assistance of TiRobot and the biopsy sheath was inserted into the lesion through the guide pin. The tumor was biopsied for pathological examination. Then the RFA needle was inserted into the nidus through the biopsy sheath for thermal ablation. Data were extracted on the associated complications, the reduction in pain at 1 month and 1 year postoperatively assessed by the visual analogue scale (VAS). A paired t‐test was used to compare the pre‐operative and post‐operative VAS scores. Results The patients included 17 males and four females with a mean age of 19.5 ± 10.4 years (range 3–45 years). Lesions were located on the femur in nine cases, on the tibia in nine cases, on the humerus in one case, on the calcaneus in one case, and on the acetabulum in one case. TiRobot‐assisted percutaneous RFA was successfully performed on all 21 patients. There was no intra‐operative or post‐operative complications observed. Pathological diagnosis of osteoid osteoma was obtained in 11 patients, but the other 10 cases were not pathologically diagnosed. The mean follow‐up time was 18.8 months (range: 12–26 months).Post‐operative VAS scores were reduced significantly in all cases. The mean VAS score decreased from 6.5 pre‐operatively to 0.5 at 1 month post‐operatively and to 0.1 at 1 year post‐operatively. Conclusion As a reliable technique for localizing and resection of nidus, TiRobot‐assisted percutaneous RFA is a safe and effective option for the treatment of osteoid osteomas.

Purpose: This study aimed to evaluate the effectiveness of CT-guided minimally invasive open surgery for treating osteoid osteoma (OO) in athletes, focusing on its clinical safety and efficacy. Methods: We reviewed medical records and imaging data of 14 athletes treated for OO from January 2014 to December 2018 using intraoperative CT-guided mini-open resection. Variables such as operation time, blood loss, incision length, and visual analogue scale (VAS) scores were analyzed to assess the outcome. Results: All 14 athletic patients, predominantly male with an average age of 21, underwent successful tumor removal, confirmed by pathological examination. Over an average followup of 37.9 months, significant improvements in pain were recorded, with no complications or recurrences related to the procedure. The mean operation metrics included a time of 27.8 minutes, blood loss of 31.1 ml, and incision length of 3.6 cm. The mean postoperative VAS scores significantly decreased, indicating effective pain management. Conclusion: CT-guided open surgery proved to be a safe and effective method for managing OO in athletes, enhancing recovery and return to sports activity without significant complications. This approach provides a viable option for surgeons treating athletes affected by this condition. [ABSTRACT FROM AUTHOR]

Objective: Percutaneous CT‐guided radiofrequency ablation (CT‐RFA) is a widely accepted procedure for treatment of osteoid osteomas. However, the application of CT‐RFA was restricted as a result of some drawbacks, such as radiation exposure, and inconvenience in general anesthesia. The primary aim of this study is to evaluate the safety and efficacy of intra‐operative TiRobot‐assisted percutaneous RFA of osteoid osteomas. Methods: We retrospectively reviewed 21 medical files of patients who were treated with percutaneous RFA of osteoid osteomas guided by the TiRobot system in our institution between March 2021 and April 2022. The three‐dimensional images obtained by a 3D C‐arm intra‐operatively were sent to the TiRobot system. The puncture point and trajectory were designed. Then the guide pin was positioned to the lesion with the assistance of TiRobot and the biopsy sheath was inserted into the lesion through the guide pin. The tumor was biopsied for pathological examination. Then the RFA needle was inserted into the nidus through the biopsy sheath for thermal ablation. Data were extracted on the associated complications, the reduction in pain at 1 month and 1 year postoperatively assessed by the visual analogue scale (VAS). A paired t‐test was used to compare the pre‐operative and post‐operative VAS scores. Results: The patients included 17 males and four females with a mean age of 19.5 ± 10.4 years (range 3–45 years). Lesions were located on the femur in nine cases, on the tibia in nine cases, on the humerus in one case, on the calcaneus in one case, and on the acetabulum in one case. TiRobot‐assisted percutaneous RFA was successfully performed on all 21 patients. There was no intra‐operative or post‐operative complications observed. Pathological diagnosis of osteoid osteoma was obtained in 11 patients, but the other 10 cases were not pathologically diagnosed. The mean follow‐up time was 18.8 months (range: 12–26 months).Post‐operative VAS scores were reduced significantly in all cases. The mean VAS score decreased from 6.5 pre‐operatively to 0.5 at 1 month post‐operatively and to 0.1 at 1 year post‐operatively. Conclusion: As a reliable technique for localizing and resection of nidus, TiRobot‐assisted percutaneous RFA is a safe and effective option for the treatment of osteoid osteomas. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate treatment of osteoid osteomas using bipolar radiofrequency ablation (RFA) and patients' quality of life before and after therapy. We retrospectively evaluated patients who underwent bipolar RFA of osteoid osteomas between 2001 and 2016. We assessed patients' symptoms before and after treatment (four weeks after treatment and long-term) using a questionnaire including severity and quality of pain on a 10-point scale (1 = no pain, 10 = severe pain), motion restrictions, pain-related sleep disorders, and necessary pain medication. In addition, we evaluated technical success, complications, hospitalization length, and patients' satisfaction with treatment. This study included 62 patients (43 [69.4%] males, 26.2 ± 13.2 years). Average nidus size was 5.7 ± 2.6 mm. The rate of technical success was 100%. All RFAs were performed without any complications. One patient showed a recurrence, resulting in a recurrence rate of 1.6%, which was successfully treated by another session of RFA. Average hospitalization length was 1.5 ± 0.5 days. A total of 36 patients (58.1%) participated in the questionnaire, reporting an average pain severity of 8.2 ± 1.6 before RFA compared to 3.4 ± 3.0 four weeks after and an average of 2.1 ± 2.3, 6.6 years after therapy, (both p < 0.001). After therapy, 31 (86.1%) patients had no pain. The majority of patients (n = 34, 94.4%) had reduced or absent motion restriction after therapy (p < 0.001). Patient satisfaction rate was 91.7%. In conclusion, bipolar RFA is a safe and effective treatment modality for osteoid osteomas and improves quality of life by reducing pain severity and motion restrictions. [ABSTRACT FROM AUTHOR]

Key Clinical Message If you encounter an unexplained case of bone marrow edema in a young patient, consider the possibility of osteoid osteoma (OO). Even in the presence of a nidus near vital structures, RFA can safely be used to treat OO.

Abstract Objective We aim to evaluate the efficacy of CT-guided percutaneous radiofrequency ablation (RFA) and surgical treatment in osteoid osteoma (OO) treated at the Medical University of Graz. Materials and methods In a single-institution study, we analysed data from January 2005 to January 2021 of patients with histological/radiological diagnosis of OO. CT and MRI scans were reviewed for typical findings. Means (with SD) and medians (with IQR) were reported for normally and non-normally distributed variables. Differences between groups were assessed using chi-squared tests and t-tests. Results One hundred nineteen patients (mean age: 21.6 ± 10.9 years; 63.9% males) with confirmed OO were retrospectively evaluated. 73 and 43 patients underwent RFA and surgery, respectively. In three cases, RFA combined with surgery was performed. Pre-intervention, 103 patients (88.8%) had undergone CT, and 101 had an MRI (87.1%). The nidus was confirmed in 82.5% of cases with CTs (85/103) and 63.4% with MRIs (64/101). The majority of nidi were located cortically (n = 96; 82.8%), most frequently in the femur (38 patients, 33.3%) with a median size of 8.0 mm (IQR: 5.0–12.0 mm). Median symptom duration before treatment was 6.0 (IQR: 4.0–13.0) months. The complication rate was 12.1% (14/116; 15.1% RFA vs. 7.0% surgery; p = 0.196). In total, 11.2% of patients had persistent symptoms after one week with clinical success rates of RFA and surgery, 86.3% and 90.7% (p = 0.647), respectively. Conclusion Compared to surgical treatment, CT-guided percutaneous RFA is a safe, minimally invasive, reliable, and efficient treatment option for OO. Critical relevance statement This article critically assesses the diagnosis and treatment of osteoid osteoma, emphasising accurate imaging, and detailing a non-invasive option for effective management. Key points • This study analyses 116 cases of OO at one institution, focusing on symptom persistence, recurrence in short-term follow-up, and complications in two study groups. • Surgery showed higher, though not statistically significant, success despite comparable symptom persistence; CT displayed typical OO features more than MRI, regardless of the intramedullary, cortical and subperiosteal location as well as the site of the affected bone. • CT-guided RFA is an effective therapeutic alternative for OO compared to surgical intervention. In case of atypical OO appearance, RFA is not the first-line treatment. Graphical Abstract

We report a case of an osteoid osteoma at the scapular glenoid that was treated with cryoablation. The patient presented with shoulder pain with subsequent CT and MRI imaging findings suspicious for an osteoid osteoma. The patient complained of persistent pain despite medical treatment and was referred to interventional radiology for consideration of ablation. CT-guided biopsy confirmed the diagnosis of osteoid osteoma and the patient underwent cryoablation of the lesion in the same session. The patient reported a substantial relief in her pain at a follow-up 4 weeks after the procedure. MRI performed 8 weeks after the procedure also confirmed radiographic remission of the lesion.

A case study details a 46-year-old woman with nine years of severe, chronic leg pain of unknown origin, despite extensive testing and treatments. Topics include the diagnostic challenges and management of osteoid osteoma, the importance of targeted imaging in difficult cases, and the impact of delayed diagnosis on patient outcomes.

Introduction: Osteoid osteoma is a benign painful bony lesion that often affects children and young adults. It is 3% of all bone tumors. It may result in growth disturbance, bony deformity, joint swelling and contractures. Long bones especially of the lower limb are the most commonly affected regions. During the initial period, the resection of nidus was performed by open surgery where a bone block was removed. This was followed by development of computed tomography (CT)-guided procedures for complete removal of nidus using various percutaneous techniques. These include CT-guided radiofrequency ablation (RFA) or trephination. If these lesions are near any important vascular structures, it becomes difficult to use RFA due to risk of injuring them. While the results of RFA are well studied, percutaneous trephination is still not widely researched. Objectives: We evaluated the results of 14 cases of osteoid osteoma treated with percutaneous drilling resection of the nidus under CT guidance and discussed the positive and negative impact of the same. Material and Methods: We included 14 patients who presented, from October 2017 to September 2020, at a tertiary level health care center. The diagnosis was established by clinical as well as imaging modalities. The patients underwent CT scan and the exact site was localized. Safe zone for percutaneous drilling was identified using contrast for vascular bundle. Percutaneous drilling was done using 8 mm reamer and complete lesion was removed under CT guidance. Patients were followed up for 2 years after the procedure and the final results were obtained in terms of pain, functional ability of limb and recurrence. Results: 13 out of 14 patients were pain-free at the end of the follow-up. One patient did have some pain after 1 year and on repeat imaging, there were changes suggestive of recurrence. The success rate was thus 13/14 patients (92.8%). The mean pre-operative pain score improved from 2.3 (range, 0–4) to 4.85 (range, 4–5) after procedure. There was no functional deficit of the limb recorded at the end of final follow up. Conclusion: CT-guided percutaneous trephination is a cost-effective alternative to available treatments protocols for Osteoid osteoma. Although newer techniques such as radio-frequency ablation are available, they are neither easily accessible nor affordable for the masses in developing countries. [ABSTRACT FROM AUTHOR]

In this narrative review, we aim to describe the clinical features, diagnosis, and management of common primary osseous tumors affecting the posterior elements of the spine in children. We searched PubMed, Mendeley, and Google Scholar using the terms primary osseous tumors of the spine in children, tumors of the posterior elements of the spine, and names of individual tumors. The clinical features, investigations, and treatment modalities were analyzed, and a narrative review of the topic was prepared. We have included 54 studies published in the last 20 years. The majority are isolated reports or case series. Tumors of the posterior elements of the spine are rare. They are common in children and the majority of them are benign. Pain and deformity are common presentations. It is better to perform thorough investigations of children complaining of back pain to rule out primary tumors of the posterior elements of the spine. [ABSTRACT FROM AUTHOR]

Osteoid osteoma is one of the most frequent benign musculoskeletal neoplasm. Radiofrequency ablation is the method of choice for non-conservative treatment of osteoid osteoma. Recently, high-intensity focused ultrasound (HIFU) has been proposed as a safer option. The objective of this study is to review the efficacy and side effects of HIFU in the management of osteoid osteoma. A comprehensive search was conducted in PubMed, Science Direct, and Clinical Key until June 30, 2022. Demographic data, baseline characteristics, success rates, pre- and post-procedure pain scores, recurrences, and complications were recorded. Eleven studies were included in this systematic review. Pooled analysis that involved 186 subjects resulted in an overall success rate of 91.94%. Recurrence was reported in two studies, in which it occurred in 4/177 (2.26%) subjects. Skin burn was found in 1 (0.54%) patients. No major or other complications were reported. Three studies compared the success rate of HIFU and RFA. Success rate was slightly higher in the RFA group with insignificant difference (p = 0.15). High-intensity focused ultrasound showed promising results. It offers a safer treatment approach for osteoid osteoma, especially in children, and can be considered for recalcitrant cases after RFA. Nonetheless, more studies are expected in the future. [ABSTRACT FROM AUTHOR]

Context: Osteoblastoma is a benign, slow-growing, but locally aggressive bone tumor. It is usually localized in the cervical vertebra but may rarely involve the laryngeal cartilage. Case description: We report a case of osteoblastoma hypopharynx in a 10-year-old boy who presented with snoring and mouth breathing. His video laryngoscopic examination showed a mass in the pyriform fossa, which could not be excised by endoscopic excision technique and hence, was referred to our center for external approach excision. The whole mass was excised en bloc via an external approach, and a Ryles tube was inserted for 10 days. Histopathological examination (HPE) report came as Osteoblastoma. Ryles tube was removed after doing a fluoroscopy to confirm normal swallowing. Conclusion: Osteoblastoma hypopharynx which has never been reported before in the literature can be treated completely by surgical excision via an open approach. [ABSTRACT FROM AUTHOR]

Osteoid osteoma is a benign osteogenic tumour traditionally treated by surgical excision or percutaneous CT-guided procedures. We describe three cases of osteoid osteomas of which the locations were difficult to access, or for which the procedure was potentially unsafe, involving treatment with zoledronic acid infusions. We report here three male 28 to 31-year-old patients with no medical history who had osteoid osteomas located at the second cervical vertebra, the femoral head, and the third lumbar vertebra respectively. These lesions were responsible for inflammatory pain requiring daily treatment with acetylsalicylic acid. Given the impairment risk, all of the lesions were ineligible for surgical or percutaneous treatment. Patients were successfully treated by 3 to 6 monthly zoledronic acid infusions. All patients experienced complete relief of their symptoms allowing aspirin discontinuation, without any side effects. In the first two cases, CT and MRI control showed nidus mineralization and bone marrow oedema regression, correlating with the pain decrease. After 5 years of follow-up there had been no recurrence of the symptoms. Monthly 4 mg zoledronic acid infusions seem to be safe and effective in the treatment of inaccessible osteoid osteomas. [ABSTRACT FROM AUTHOR]

Study design: A literature review. Objective: The aim of this review is to provide an overview of benign and malignant primary spine tumors and a balanced analysis of the benefits and limitations of (and alternatives to) surgical treatment with en bloc resection. Summary of background data: Primary spine tumors are rare but have the potential to cause severe morbidity, either from the disease itself or as a result of treatment. The prognosis, goals, and treatment options vary significantly with the specific disease entity. Appropriate initial management is critical; inappropriate surgery before definitive treatment can lead to recurrence and may render the patient incurable, as salvage options are often inferior. Methods: We performed a comprehensive search of the PubMed database for articles relevant to primary spine neoplasms and en bloc spine surgery. Institutional review board approval was not needed. Results: Although Enneking-appropriate en bloc surgery can be highly morbid, it often provides the greatest chance for local control and/or patient survival. However, there is growing data to support modern radiotherapy as a feasible and less morbid approach to certain primary neoplasms that historically were considered radioresistant. Conclusions: Choosing the optimal approach to primary spine tumors is complex. A comprehensive and up-to-date assessment of the evidence is required to guide patient care and to balance the often-competing goals of prolonging life and preserving quality of life. [ABSTRACT FROM AUTHOR]

Background: The use of intraoperative CT navigation to manage osteoid osteoma is not common. We report our experience managing osteoid osteoma in the appendicular skeleton using an intraoperative AIRO CT navigation system. Materials & methods: Between May 2013 and December 2022, 59 patients underwent Navigation-assisted excision of osteoid osteoma in the appendicular skeleton. Our primary study outcome was to assess for recurrence of the tumour with recurrence of symptoms. For our secondary outcomes, we evaluated the complications associated with the procedure and evaluated the histological slides of all patients to see for the presence of nidus. Results: Of the 58 patients available for review, no patient had a lesion recurrence, and all were symptom-free at an average follow-up of 45.6 months (6-100). Two patients (3.5%) had a superficial infection managed conservatively, and 43 patients (74.1%) had the presence of nidus in curetted samples. No patient developed a pathological fracture after the procedure. Conclusion: Using intraoperative CT navigation to manage osteoid osteoma in the appendicular skeleton is safe, minimally invasive, and effective in completely removing the nidus with a negligible complication rate. The absence of nidus on histology should not be a concern to clinicians once thorough burring and verification of excision of nidus has been confirmed intra-operatively. Study design: Retrospective Case Series. [ABSTRACT FROM AUTHOR]

This article presents a case of skin necrosis following computed tomography-guided radiofrequency ablation (RFA) treatment in an 18-year-old female patient with osteoid osteoma. Although RFA is generally considered safe and effective for managing bone tumors, serious complications are rare but require careful attention. The patient developed a necrotic wound on her right forearm 2 days after the RFA procedure, necessitating wound care, antibiotic treatment, and reconstruction surgery. Skin necrosis is a severe complication associated with RFA, and prompt and appropriate management is crucial for favorable patient outcomes. The awareness of potential complications and adherence to proper procedural techniques are essential when using RFA for bone tumor management.

Osteoid osteoma of the cuneiform bone is an exceedingly rare and easily missed cause of foot pain. The uncharacteristic and nonspecific radiographs of such intra‐articular osteoid osteoma further increase difficulty in making the diagnosis. To date, there has been no description of intra‐articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration in any published literatures. We present a case of intra‐articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration, who underwent curettage, allograft bone graft, and navicular‐cuneiform arthrodesis. The patient presented with radiographic bone union, full motor function recovery and pain‐free at the 22‐month follow‐up. This report adds to the existing literature. Intra‐articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration is an exceedingly rare and easily missed cause of foot pain. It proves a complicated and challenging task to identify intra‐articular osteoid osteoma. Clinicians should be particularly careful not to exclude the possibility of arthritis and, thus, vigilant when choosing the surgical option.

Background Osteoid osteoma is a benign osteogenic tumor that occurs mostly in the femoral stem, while osteoid osteoma occurring in the lumbar vertebral body is a relatively rare case. To minimize treatment‐related complications, a computer‐assisted navigation fully visualized spinal endoscopy was used. Ultimately, the pathology was diagnosed as osteoid osteoma. Case Presentation We report a 19‐year‐old adult male with low back pain that worsened at night and CT, MRI imaging showed an abnormal signal shadow at the posterior margin of the lumbar vertebral body. Due to the proximity of the lesion to the spinal canal and adjacent to the nerve roots, it was difficult to precisely localize the lesion by purely endoscopic or open procedures, and if necessary, the resection of surrounding tissues had to be expanded, causing unnecessary damage to the surrounding tissues. Therefore, we choose computer‐assisted navigation fully visualized spinal endoscopy to perform the treatment. Conclusion In this case, we report an osteoid osteoma that occurs less frequently in the lumbar vertebral body. Using computer‐assisted navigation with fully visualized spinal endoscopy, we successfully resected the osteoid osteoma at the posterior margin of the L3 vertebral body preoperatively by computer‐planned path with intraoperative visualization endoscopy, minimizing the damage to spinal stability. Computer‐assisted navigation with visualization endoscopy provides a more precise and minimally invasive approach to the treatment of osteoid osteoma of the spine.

Background: Osteoid osteoma is a painful benign osteoblastic lesion occurring mainly in the long bones. On the one hand, some studies have declared that post-treatment CT cannot determine the success or failure of radiofrequency ablation, on the other hand, some studies have stated that imaging follow-up can be helpful or even mandatory in some cases. The present study aims to evaluate Osteoid Osteoma's imaging features before or after radiofrequency ablation with or without curettage and during the follow-up period. Methods: In this retrospective and cross-sectional study, we reviewed twenty seven Osteoid Osteoma patients with radiofrequency ablation who were assessed via drilling with or without curettage from March 2015 to December 2019 at Nemazi Hospital, Shiraz University of Medical Sciences. Results: Radiofrequency ablation with drilling was used in 22(81.5%) patients, and for the rest 5(18.5%), radiofrequency ablation with curettage and drilling was performed as a treatment procedure. The overall clinical success rate was 92.6%(25/27), with a low complication rate (7.4%). The mean diameter of nidus in pre/pos treatment was 3.46±2.02 and 2.22±1.75 mm, respectively. Femur 12(44.4%) was the most common bone in the patients. Significant differences between pre/post treatment follow up examinations in nidus size (P=0.03), nidus diameter (P=0.02), bone and calcification size (P=0.005) were detected. Additionally, it depicts that the mean values of tumor size and cortical thickening decreased after treatment. Conclusion: It is noteworthy that the present study had some limitations, including the small sample size and the relatively short follow-up period. There is no significant difference between radiofrequency ablation after drilling and curettage in treating Osteoid Osteoma. It is concluded that although there was a significant difference in pre/post-treatment imaging, there is no need for continuous imaging follow-up in treated patients without clinical complications such as pain to mitigate radiation dose risks and healthcare expenses.

Osteoid osteoma is a benign bone tumor commonly occurring in the diaphysis and metaphysis of long bones. Only a few cases were reported in the literature about the rare location of epiphyseal osteoid osteoma and all were treated surgically. Herein, we report a rare case of an epiphyseal tibial osteoid osteoma, in a 14-year-old boy, which was initially diagnosed by imaging and confirmed by histopathology. To the best of our knowledge, this is the first case of an epiphyseal osteoid osteoma treated successfully by CT-guided radiofrequency ablation in a pediatric patient with a good outcome and no detrimental effects. The case highlights the rarity of such presentation, the importance of early imaging and diagnosis, and the success of CT-guided radiofrequency ablation in the treatment of epiphyseal osteoid osteoma.

OBJECTIVE: Visfatin is currently a cytokine that is extensively researched in the field of bone diseases. In this prospective study, we aimed to investigate the potential of serum visfatin levels as a biomarker for the diagnosis of osteoid osteoma. PATIENTS AND METHODS: This study included a cohort of 20 patients diagnosed with osteoid osteoma (Group 1) and 30 healthy individuals (Group 2). The age, gender, cyst sizes, and visfatin values of all participants were documented and analyzed. RESULTS: There was a significant difference in visfatin levels between the two groups. The median visfatin level in Group 1 was 6.13 ng/ml (IQR: 4.21-8.08), while in Group 2, it was 15.83 ng/ml (IQR: 11.11-20.6). The difference was statistically significant (p<0.000). The optimal cutoff value for visfatin was found to be 7.74 ng/ml, which had a 93% sensitivity and 78% specificity. An area under the curve of receiver operating characteristic (ROC) analysis of 0.85 indicates good diagnostic performance. CONCLUSIONS: Our study revealed a significant decrease in visfatin levels among patients diagnosed with osteoid osteomas in comparison to the healthy control group. The ROC analysis revealed that visfatin exhibited a commendable diagnostic capacity, indicating its potential utility as a biomarker for osteoid osteoma. [ABSTRACT FROM AUTHOR]

Background: The location and proximity to the spinal cord in spinal osteoid osteoma can increase the likelihood of an incomplete resection. Intraoperative bone scintigraphy (IOBS) can be used to verify location and complete surgical resection. Objective: To review our experience using IOBS for resection of intraspinal osteoid osteoma. Methods: IRB approved, retrospective review of IOBS-guided resection over 10 years. Patients underwent injection of 200 uCi/kg (1–20 mCi) 99mTc-MDP 3–4 h prior surgery. Portable single-headed gamma camera equipped with a pinhole collimator (3- or 4-mm aperture) was used. Images were obtained pre-operatively, at the start of the procedure, and intraoperatively. Operative notes were reviewed. Evaluation of recurrence and clinical follow-up was performed. Results: Twenty IOBS-guided resections were performed in 18 patients (median age 13.5 years, 6–22 years, 12 males). Size ranged 5–16 mm, with 38.9% (7/18) cervical, 22.2% (4/18) thoracic, 22.2% (4/18) lumbar, and 16.7% (3/18) sacral. In all cases, IOBS was able to localize the lesion. After suspected total excision, IOBS altered the surgical plan in 75% of cases (15/20), showing residual activity prompting further resection. Median length of follow-up was 6 months (range 1–156 months) with 90% (18/20) showing complete resection without recurrence. Two patients had osteoid osteoma recurrence at 7 and 10 months following the original resection, requiring re-intervention. Conclusions: IOBS is a useful tool for real-time localization and assessment of spinal osteoid osteoma resection. In all cases, IOBS was able to localize the lesion and changed surgical planning in 75% of cases. Ninety percent of patients achieved complete resection and remain recurrence free. [ABSTRACT FROM AUTHOR]

Background: Percutaneous CT-guided cryoablation is an emerging technique for treating bone tumors. However, experience with using this procedure for osteoid osteomas in pediatric patients remains limited. Our study aims to assess its technical feasibility, clinical efficacy, and safety in children treated under conscious anesthesia. Methods: We conducted a retrospective study of consecutive pediatric patients who underwent CT-guided percutaneous cryoablation for osteoid osteomas at our institution between September 2017 and March 2021. All patients received conscious anesthesia. Data on peri-procedural VAS scores, post-procedural VAS scores, imaging findings, and nonsteroidal anti-inflammatory drug (NSAID) usage rates were collected for each patient. Technical success was defined as proper cryoprobe placement at the nidus center, while clinical success referred to pain relief without NSAID use. Intra- and post-operative complications were also evaluated. Results: Nine patients underwent CT-guided percutaneous cryoablation for osteoid osteomas under conscious sedation, with a 100% overall success rate with low peri-procedural and median VAS scores (p < 0.01). No complications were observed during or after the procedure. Conclusions: CT-guided percutaneous cryoablation of pediatric osteoid osteomas is an effective and safe minimally invasive procedure feasible under conscious anesthesia, holding promise as a valuable treatment option. [ABSTRACT FROM AUTHOR]

Objectives: The diagnosis of osteoid osteomas (OO) about the hip can be challenging as presenting symptoms can mimic other, more common, periarticular pathologies. Our aims were to identify the most common misdiagnoses and treatments, mean delay in diagnosis, characteristic imaging features and provide tips for avoiding diagnostic imaging pitfalls for patients with OO of the hip. Methods: We identified 33 patients (34 tumors) with OO about the hip who were referred for radiofrequency ablation between 1998 and 2020. Imaging studies reviewed included radiographs (n = 29), CT (n = 34), and MRI (n = 26). Results: The most common initial diagnoses were femoral neck stress fracture (n = 8), femoroacetabular impingement (FAI) (n = 7), and malignant tumor or infection (n = 4). The mean time from symptom onset to diagnosis of OO was 15 months (range, 0.4–84). The mean time from initial incorrect diagnosis to OO diagnosis was 9 months (range, 0–46). Conclusions: The diagnosis of OO of the hip is challenging, with up to 70% of cases initially misdiagnosed as a femoral neck stress fracture, FAI, bone tumor, or other joint pathology in our series. Consideration of OO in the differential diagnosis of hip pain in adolescent patients and awareness of the characteristic imaging findings are critical for making an accurate diagnosis. Key Points: • The diagnosis of osteoid osteoma of the hip can be challenging, as demonstrated by long delays in time to initial diagnosis and high rates of misdiagnoses which can lead to inappropriate interventions. • Familiarity with the spectrum of imaging features of OO, especially on MRI, is imperative given the increase in the utilization of this modality for the evaluation of young patients with hip pain and FAI. • Consideration of OO in the differential diagnosis of hip pain in adolescent patients and awareness of the characteristic imaging findings, including bone marrow edema and the utility of CT, are critical for making a timely and accurate diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to develop an accessible step-wise management algorithm for the management of pediatric spinal osteoid osteomas (OOs) based on a systematic review of the published literature regarding the diagnostic evaluation, treatment, and outcomes following surgical resection. Methods: A systematic review of the literature was conducted on PubMed to locate English language studies reporting on the management of pediatric spinal OOs. Data extraction of clinical presentation, management strategies and imaging, and treatment outcomes were performed. Results: Ten studies reporting on 85 patients under the age of 18 years presenting with OOs were identified. Back pain was the most common presenting symptom, and scoliosis was described in 8 out of 10 studies, and radicular pain in 7 out of 10 studies. Diagnostic, intraoperative, and postoperative assessment included radiographs, computed tomography (CT) scans, magnetic resonance imaging (MRI), bone scans, and frozen section. Treatment options varied, including conservative management, open surgical resection with or without intraoperative imaging, and percutaneous image-guided treatment. All included studies described partial or complete resolution of pain in the immediate postoperative period. Conclusions: The proposed algorithm provides a suggested framework for management of pediatric spinal OOs based on the available evidence (levels of evidence: 3, 4). This review of the literature indicated that a step-wise approach should be utilized in the management of pediatric spinal OOs. [ABSTRACT FROM AUTHOR]

A 15-year-old boy presented with left-sided hip pain and imaging consistent with the diagnosis of femoroacetabular impingement. Following hip arthroscopy, which included an osteochondroplasty, labral repair, and capsular repair, the patient's anterior hip pain improved. However, his deep aching hip pain persisted until an ischial osteoid osteoma was identified and treated with radiofrequency ablation. At 3 years follow-up, the patient reports high satisfaction and minimal pain. We present this case to illustrate the importance of considering all potential causes of persistent hip pain following hip arthroscopy, including benign bone tumors which may be difficult to visualize on plain radiographs.