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Laminectomy for the Removal of Thoracic Ossification of the Ligamentum Flavum TOLF Using Ultrasonic and Conventional Osteotomes
Published on: April 21, 2023
Clinical Application of an Ultrasonic Bone Scalpel in the Treatment of Osteoid Osteoma: A Single-Center Pilot Study
He Dong1, Jing Han, Binghui Yang
1Department of Orthopaedic Oncology, Shanghai General Hospital, Shanghai Bone Tumor Institution, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Background:
No previous studies have investigated the application of an ultrasonic bone scalpel (UBS) in the treatment of osteoid osteoma (OO). We aimed to evaluate the safety and effectiveness of UBS use, either as a standalone treatment or in combination with radiofrequency ablation (RFA), for managing OO.
Methods:
In this single-center study, a retrospective analysis was performed that included patients who were radiographically or histologically diagnosed with OO at Shanghai General Hospital from September 2022 to November 2023. The treatment modalities were RFA, UBS, or RFA and UBS combined. Demographic data, clinical presentation, and radiographic characteristics were collected and analyzed. Treatment failure was defined as symptom recurrence, reoperation, or the occurrence of complications.
Results:
A total of 77 patients (mean age, 16.12 ± 10.91 years; 70% male; 100% Han Chinese) were included. Most lesions (60%) were located in the femur, and the mean nidus diameter in the cohort was 11.58 ± 6.57 mm. Imaging classification revealed cortical (36%), subperiosteal (7%), cancellous (32%), and intra-articular (25%) types. Treatment included RFA (30%), UBS (34%), and RFA+UBS (36%). Visual analogue scale (VAS) pain scores decreased significantly from 4.55 ± 1.12 preoperatively to 0.99 ± 0.60 on postoperative day 3 and to 0.25 ± 0.52 at 1 month (p < 0.001). No major complications occurred. The treatment success rate was 97% during the 18 to 34 months of follow-up (mean, 27.32 ± 5.05 months).
Conclusions:
The UBS, whether used alone or in combination with RFA, effectively improved short-term pain relief and functional recovery in patients with OO, with no major complications. Similar to RFA, UBS use appears to be a safe and reliable treatment option for OO. Because each treatment approach has its own advantages, it is recommended to select the surgical method on the basis of the lesion characteristics. This recommended treatment algorithm supports clinical decision-making and broadens minimally invasive treatment options for OO.
Level Of Evidence:
Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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