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CT guided RadioFrequency Ablation in 24 patients with spinal osteoid osteomas J.A.M Bramer, dep. Orthopedic surgery P.D.S. Dijkstra, dep. orthopedic surgery.

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Presentation on theme: "CT guided RadioFrequency Ablation in 24 patients with spinal osteoid osteomas J.A.M Bramer, dep. Orthopedic surgery P.D.S. Dijkstra, dep. orthopedic surgery."— Presentation transcript:

1 CT guided RadioFrequency Ablation in 24 patients with spinal osteoid osteomas J.A.M Bramer, dep. Orthopedic surgery P.D.S. Dijkstra, dep. orthopedic surgery W.R.Obermann, dep. radiology A.H.M. Taminiau, dep. orthopedic surgery

2 CTOS 2005 Osteoid Osteoma in the spine Benign Nidus < 20 mm 10% in spine Pain Scoliosis

3 CTOS 2005 Open surgery Difficult localization Incomplete excision High recurrence rate High complication rate Ozaki, CLINICAL ORTHOP. REL. RES Number 397, 394–402

4 CTOS 2005 Radio Frequency Ablation RF ablation under CT guidance Bonopty drilling system Radi Medical Systems, Uppsala, Sweden RF ablation probe Radionics-RFG3C RF-lesion Generator System, Burlington, USA

5 CTOS 2005 RadioFrequency Ablation de Berg, JC Lancet 1995;

6 CTOS 2005 Procedure Materials RF needle biopsy drills cannula + stylet RF needle biopsy drills cannula + stylet

7 CTOS 2005 Procedure General Anesthetics

8 CTOS 2005 Procedure Positioning of probe

9 CTOS 2005 S3

10 CTOS 2005 Radio Frequency Ablation

11 CTOS 2005 Study Period Patients24 Follow up54 months (6-120)

12 CTOS 2005 Material and Methods Gender16 ♂, 8 ♀ Median age 23 years (8 – 55) Median size lesion8.5 mm (5 - 15) Volume0,7 cm 3 (0,1-2,5)

13 CTOS 2005 Location 24 locations in 24 patients Cervical 3 Thoracic10 Lumbar 7 Sacral 4

14 CTOS 2005 Distance lesion to vital structures ≤ 2mm in 15 patients : Dural sac12 Foramen10 Vertebral artery 1 Nerve root 1 Hadjipavlou AG Spine (22):E472-7

15 CTOS 2005 Biopsy in all patients No material7 Insufficient material4 Confirming13 Material and Methods

16 CTOS 2005 Location in vertebrae Posterior Pedicle 8 Arch 7 Pars interarticularis 4 Transverse process 2 Anterior Vertebral body3

17 CTOS 2005 Probe positioning Median Tumor size Number of pat. 1x 7 mm 11 2x 10 mm 7 3x4x6x 13 mm 14 mm 222 Procedures

18 CTOS 2005 Results Residual diseasein 5 patients: Second procedure3(3, 9 and 10 months) Third procedure 1(28 months) Open surgery1(6 months)

19 CTOS 2005 Results DISEASE FREE AT FINAL FU 100% NO PAIN

20 CTOS 2005 Results Scoliosis Before procedure58%(14) After procedure17%(4)

21 CTOS 2005 Results ComplicationsNONE Skin Burns0 Neurological deficit0 Sans N, Radiology 1999;212: 687–92.

22 CTOS 2005 C3 mid lesion

23 CTOS 2005 C3 MRI T1

24 CTOS nd RF Ablation C3 3 months

25 CTOS nd RF Ablation C3 8 months

26 CTOS 2005 Conclusion CT-guided RF ablation of spinal osteoid osteomas is a successful minimal invasive procedure It is safe if the thermo probe is positioned at least 5 mm from vital structures Open surgery in case of tumor adherent to nerve root

27 The combination of percutaneous radiofrequency heat ablation and vertebroplasty seems to be a promising, feasible, minimally invasive technique in the treatment of spinal metastases with cortical defects


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