CT-Guided Percutaneous Drilling of Osteoid Osteoma: A Safe, Minimally Invasive and Cost-Effective Method

CT-guided percutaneous drill resection (PDR) for osteoid osteoma fell out of vogue with the advent of radiofrequency ablation (RFA). However, the routine use of RFA is offset by its high cost and need for specialized instrumentation.

This study is an analysis of our series of patients treated with PDR, to know its efficacy, safety and cost-effectiveness.

This study is a retrospective analysis of prospectively collected data of 33 patients with a mean age of 10.03 years (2-21 years 13:10 M:F). The proximal femur was the commonest location, followed by shaft femur, tibial shaft, pubic ramus and lateral humeral condyle. Three were recurrences. The procedures were performed by one of four fellowship-trained paediatric orthopaedic surgeons, using a standard protocol with the help of a radiologist. CT-guided drilling was performed under sedation/short general anaesthesia using a guidewire for identification, followed by sequential drilling using a 6.5 mm cannulated drill or a triple ream drill. Patients were hospitalized overnight for pain relief and allowed protected weight bearing as per pain tolerance. They were evaluated weekly for 2 weeks and 3 monthly thereafter.

The mean final follow-up was 19.72 months (6 months to 58 months). All patients had complete resolution of symptoms within 3 days of the procedure. There were no major complications and there were two minor complications (haematoma and cutaneous hypoaesthesia). There were no recurrences till the last follow-up.

This study, one of the first and largest from India about CT-guided PDR, shows that this method can still be safely and effectively used as a primary treatment modality in OO, especially in economically challenged population. It is much more cost-effective than RFA, can be used even for recurrent tumours and can be safely be performed by a general orthopaedic surgeon without any special instrumentation.