Surgery vs Radiofrequency Ablation in the Management of Spinal Osteoid Osteomas: A Spine Oncology Referral Centre Comparison Analysis of 138 cases

BACKGROUND: Osteoid Osteomas (OOs) are benign bone forming tumours that, usually, occur in the extremities with about 10% of them arising in the spine more commonly in the posterior elements. The aim of this study is to evaluate the long-term results of patients suffering from Spinal Osteoid Osteoma treated with Surgery and Radiofrequency Ablation.

MATERIALS AND METHODS: A retrospective comparison analysis of data prospectively collected from two cohorts of consecutive patients diagnosed with OO of the spine treated at the same Institute from November 2002 to February 2019. The first cohort included patients submitted to an intralesional extracapsular excision of the lesion (Surgery-group); the second cohort included patients submitted to radiofrequency ablation (RFA-group).

RESULTS: Surgery-group showed a local recurrence (LR) rate of 1.7% versus a recurrence rate of 12.5 % in the RFA-group with a statistically significant difference in the disease-free survival at longest follow-up (p=0.012). No statistically significant differences were observed in LR rate stratified for level and site of lesion. No complications were observed in both groups at the time of first procedure.

CONCLUSION: Surgery and RFA are both safe and effective interventional procedures for the management of Spinal Osteoid Osteoma although RFA is associated with a higher recurrence rate. Treatment should be tailored according to the relationship of lesions with neural structures and to advantages and disadvantages of each technique.