Beyond bone grafting: techniques in the surgical management of benign bone tumors

The traditional surgical treatment of benign bone tumors has been curettage and autologous bone graft or marginal resection of expendable bones. These procedures are associated with good results in most patients and should be considered the standard against which newer treatments are compared. Recently, however, surgeons have been evaluating the results of treatments using limited surgical approaches, including percutaneous treatments, alternatives to autograft bone, and thermal or cytotoxic adjuvant therapies. The goal has been to improve patient outcomes by decreasing perioperative morbidity and enhancing surgical efficiency. This process has been facilitated by the availability of multiple bone grafting materials and substitutes, the use of cross-sectional imaging, and technology such as that used with radiofrequency ablation. Techniques using these therapies in two benign bone tumor models are described. The use of percutaneous radiofrequency ablation, now used for both benign and malignant disease, is reviewed as a surgical alternative for osteoid osteoma. The role of adjuvant therapies such as liquid nitrogen and phenol, as well as the indications for resection, are described in the management of giant cell tumors of bone.