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Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
The indication for gamma probe-guided surgery of spinal osteoid osteomas
A Hempfing1, J Hoffend, R G Bitsch
1Orthopaedic Department, University of Heidelberg, Heidelberg, Germany. axel@hempfing.de
Summary
Probe-guided surgery (PGS) offers a viable alternative to radiofrequency ablation (RFA) for spinal osteoid osteomas when RFA is contraindicated. This technique aids in precise tumor localization and complete resection, minimizing complications.
Area of Science:
- Orthopedic Surgery
- Oncology
- Radiology
Background:
- CT-guided radiofrequency ablation (RFA) is standard for osteoid osteomas but limited in spinal cases due to neural structure risks.
- RFA use in spinal lesions is debated, often requiring a cortical shell between the tumor and spinal canal.
Purpose of the Study:
- To evaluate the efficacy and safety of probe-guided surgery (PGS) for spinal osteoid osteomas where RFA is not applicable.
- To assess PGS's ability to facilitate accurate tumor localization and complete resection in challenging spinal cases.
Main Methods:
- Seven patients with spinal osteoid osteoma unsuitable for RFA underwent open resection using PGS.
- Intraoperative tumor localization was achieved using a handheld radiation probe guided by preoperative bone scintigraphy.
Main Results:
- All patients showed a 'hot-spot' indicating tumor presence preoperatively.
- Tumor resection resulted in a mean signal decrease of 68% in the operative field, suggesting complete excision.
- After a mean 17-month follow-up, one patient reported residual pain, with no tumor recurrence observed.
Conclusions:
- Probe-guided surgery (PGS) is a recommended alternative for spinal osteoid osteomas when RFA is not feasible.
- PGS facilitates intraoperative localization and complete tumor resection, potentially reducing complications associated with spinal surgery.
