Treatment of Osteoid Osteoma by Percutaneous Bone Resection and Drilling (PEBORD): a Series of 121 Cases

Osteoid osteoma is a benign osteogenic tumor in adolescents and young adults. Its treatment is surgical although thermocoagulation or percutaneous resection have supplanted « en block » open excision. We report our experience of 121 cases treated between 1987 and 2013 with this procedure combined with CT assistance.A specific ancillary equipment was needed for resection. The nidus was identified on the best relevent CT-cut. A 2 cm incision was made and a guide wire inserted to lead the specific ancillary to the nidus. This material included a drill bit and a trephine with a bone plug for the purpose of pathological examination) and a milling. The average duration of the procedure was 60 minutes. Irradiation was moderate (patient 270 mGy.cm, operator 0.02 mSv).Hospital stay was short. A partial weight-bearing was recommended for a few days with crutches. The patient was controlled at 60 days with a CT scan and 1 year postoperativelyOne hundred and twenty one patients (4 to 35 years old) were treated between June 1987 and December 2013, with a minimum follow-up of 1 year. The tumor location was the lower limb in 89% of cases (femoral neck 39%, femur 16%, tibia 31%).The risk for a fracture should be taken in account in the femoral neck (2 cases in 48 proximal femur sites ); strict non weight-bearing for 1 month is therefore advised.True recurrence is very rare (2 cases); in 6 cases it was a prefills due to a technical failure of the procedure with incomplete resection.A formal diagnosis using scintigraphy (hyperfixation) and CT scan (to visualize the nidus) is a prerequisite to the procedure. Preoperative strategy is determined with the help of the radiologist (patient installation, incision) The nidus in the femoral neck is a common location and its resection is difficult. The anterior approach should therefore be preferred.Thermocoagulation (radiofrequency or laser) is an « alternative » method with comparable reported results although we do not have any experience in its use .This study confirmed the value of PBRD in the treatment of OO. It showed that it was a safe and effective procedure in which requires a radiological environment.