From the Guidelines
Osteoid osteoma management typically involves CT-guided radiofrequency ablation (RFA) as the preferred definitive treatment for patients with inadequate pain control or those who cannot tolerate long-term NSAID therapy, with a success rate exceeding 90% 1. For symptomatic relief, NSAIDs such as ibuprofen (400-800mg every 6-8 hours) or naproxen (250-500mg twice daily) are first-line options and can be continued for several months, as some lesions may resolve spontaneously over 2-3 years.
Key Considerations
- The characteristic night pain of osteoid osteoma responds dramatically to NSAIDs because the tumor produces high levels of prostaglandins, which sensitize nerve endings.
- Complete removal or ablation of the nidus is essential for cure, as incomplete treatment commonly leads to recurrence.
- CT without IV contrast is usually appropriate for a suspected primary bone tumor in patients with radiographs or clinical presentations suggestive of osteoid osteoma 1.
- Alternative minimally invasive options include CT-guided laser ablation, microwave ablation, or cryoablation.
- Surgical excision is reserved for cases where minimally invasive techniques fail or are unavailable.
Diagnostic Imaging
- CT can be used to characterize and define the extent of the lesion, such as with the nidus of an osteoid osteoma 1.
- Low-dose protocols have been developed and implemented for CT scans to reduce radiation exposure.
- IV iodine-based contrast is almost never warranted in the perioperative setting, unless tumor or infection is suspected and MRI with contrast cannot be obtained due to a contraindication 1.
From the Research
Osteoid Osteoma Management Options
- Surgical treatment is frequently used in clinic, including open surgery and percutaneous ablation, such as radiofrequency ablation, cryoablation, and microwave ablation 2
- Percutaneous ablation and open surgery are safe and reliable for osteoid osteomas, and the technical success rate of percutaneous ablation is higher than that of open surgery 2
- Open surgery and cryoablation can be selected for osteoid osteomas close to the nerve and atypical sites, while radiofrequency ablation and microwave ablation can be selected for osteoid osteomas in most other sites 2
Non-Operative Treatment
- Non-operative treatment can be considered as an option since the natural history of osteoid osteoma is that of spontaneous healing 3
- Administration of nonsteroidal anti-inflammatory drugs (NSAIDs) accelerates spontaneous healing of osteoid osteoma 4
- The healing rate of osteoid osteoma with regular dose of NSAIDs was 67% at the time of the study, which may be improved up to 92% 4
Minimally Invasive Techniques
- Minimally invasive techniques, such as computed tomography-guided percutaneous radiofrequency thermal ablation and laser photocoagulation, have become the methods of choice for the treatment of all localizations except those in contact with neural structures 5
- Radiofrequency ablation is the preferred technique, although cryoablation seems superior in terms of nerve damage and immunotherapy effect 6