SIR 2024
Pain Management/MSK
Russell Thompson, MD, PhD (he/him/his)
Integrated IR resident
Duke University School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Alan Alper Sag, MD
Assistant Professor, Interventional Radiology and Orthopaedic Surgery
Duke University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Charles Y. Kim, MD, FSIR
Professor and Chief of Interventional Radiology
Duke University
Financial relationships: Full list of relationships is listed on the CME information page.
While radiofrequency ablation (RFA) is the historically dominant therapy for the treatment of osteoid osteoma, recent single-arm studies have shown cryoablation to be both safe and effective. Furthermore, studies have shown that cryoablation has less destructive effects to peri-joint collagenous structures, where osteoid osteoma often occurs. The purpose of this study was to directly compare outcomes after RFA and cryoablation for osteoid osteoma treatment at a single institution.
Materials and methods: Retrospective review of our procedural database revealed 100 thermal ablation procedures performed in 94 patients from 2004-2023 (61 male, 33 females, mean age 15.5 years, range 3-66 years). All procedures were performed using CT-guidance. Clinical success was defined as the complete resolution of pain for at least 3 months. Recurrent osteoid osteoma was defined as the recurrence of significant pain that was similar to the initial presentation with compatible imaging appearance and requiring subsequent medical, interventional, or surgical therapy. Comparison between groups was performed with the chi-squared and log-rank tests.
Results: Osteoid osteoma location was in the leg in 75 patients, axial skeleton in 15, hand or food in 6, and arm in 4. Average lesion size of was 9.4 mm. A total of 59 patients underwent RFA and 41 underwent cryoablation for treatment of their presumed osteoid osteoma. The clinical success rate was 52/59 (88%) for RFA and 39/41 (95%) for cryoablation, p=0.23. The rate of recurrence was 7/59 (12%) in the RFA cohort and 0% in the cryoablation cohort (p=0.03). One patient in the cryoablation group developed osteomyelitis requiring surgical debridement and one patient, with a sacral lesion, was admitted for transient leg weakness. No major complications were seen in the RFA group.
Conclusion:
In this comparative study, cryoablation and RFA showed equivalent clinical success rates and safety profiles for the treatment of osteoid osteoma with similar clinical success rates. A decreased rate of recurrence with cryoablation warrants further investigation.