LETTER TO THE EDITOR
TREATMENT OF OSTEOID OSTEOMA IN THE VERTEBRAL BODY OF THE LUMBAR SPINE BY RADIOFREQUENCY ABLATION
Alexandre Fogaça Cristante, Tarcisio Barros Filho, Reginaldo Perilo de Oliveira, Almir F Barbarini, William GJ Teixeira
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil
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A REPORT OF 2 CASES" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "795" "paginaFinal" => "798" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 593 "Ancho" => 2045 "Tamanyo" => 119324 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Thorax CT-scan showing a lung abscess in a patient with <span class="elsevierStyleItalic">Rhodococcus equi</span> bacteremia (B). The normal CT-scan 1 month before symptoms (A). 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Sorbello, Edivaldo M. Utiyama, José G. Parreira, Dario Birolini, Samir Rasslan" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Mauricio P." "apellidos" => "Sorbello" ] 1 => array:2 [ "nombre" => "Edivaldo M." "apellidos" => "Utiyama" ] 2 => array:2 [ "nombre" => "José G." "apellidos" => "Parreira" ] 3 => array:2 [ "nombre" => "Dario" "apellidos" => "Birolini" ] 4 => array:2 [ "nombre" => "Samir" "apellidos" => "Rasslan" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222028794?idApp=UINPBA00004N" "url" => "/18075932/0000006200000006/v1_202212060917/S1807593222028794/v1_202212060917/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">LETTER TO THE EDITOR</span>" "titulo" => "TREATMENT OF OSTEOID OSTEOMA IN THE VERTEBRAL BODY OF THE LUMBAR SPINE BY RADIOFREQUENCY ABLATION" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "791" "paginaFinal" => "794" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Alexandre Fogaça Cristante, Tarcisio Barros Filho, Reginaldo Perilo de Oliveira, Almir F Barbarini, William GJ Teixeira" "autores" => array:5 [ 0 => array:3 [ "nombre" => "Alexandre Fogaça" "apellidos" => "Cristante" "email" => array:1 [ 0 => "aacristante@uol.com.br" ] ] 1 => array:2 [ "nombre" => "Tarcisio Barros" "apellidos" => "Filho" ] 2 => array:2 [ "nombre" => "Reginaldo Perilo" "apellidos" => "de Oliveira" ] 3 => array:2 [ "nombre" => "Almir F" "apellidos" => "Barbarini" ] 4 => array:2 [ "nombre" => "William GJ" "apellidos" => "Teixeira" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil" "identificador" => "aff1" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig2" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 627 "Ancho" => 843 "Tamanyo" => 35800 ] ] "descripcion" => array:1 [ "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Computed tomography demonstrating an area of hypoattenuation surrounded by an area of hyperattenuation (bone sclerosis).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Osteoid osteoma is a rare bone tumor initially described by Jaffe in 1935.<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a> It is characterized as a bone-producing tumor that is most frequently observed in the lower extremities of children or young adults (11-22 years). Osteoid osteoma is differentiated from osteoblastoma according to size. Osteoid osteoma is smaller than 1.5 centimeters in diameter.<a class="elsevierStyleCrossRef" href="#bib2"><span class="elsevierStyleSup">2</span></a></p><p id="para20" class="elsevierStylePara elsevierViewall">In approximately 10% to 25% of the cases,<a class="elsevierStyleCrossRefs" href="#bib3"><span class="elsevierStyleSup">3–8</span></a> the tumor is observed in the vertebral column with a predilection for posterior elements of the vertebrae.<a class="elsevierStyleCrossRefs" href="#bib9"><span class="elsevierStyleSup">9–11</span></a> In only 10% of the cases in which the spine is affected<a class="elsevierStyleCrossRef" href="#bib12"><span class="elsevierStyleSup">12</span></a> is it found in the vertebral body, but involvement of the spine is more common in the lumbar vertebrae.<a class="elsevierStyleCrossRefs" href="#bib12"><span class="elsevierStyleSup">12,13</span></a> Here the disease is characterized by localized pain in the affected vertebra,<a class="elsevierStyleCrossRefs" href="#bib14"><span class="elsevierStyleSup">14,15</span></a> and possibly by radiating pain similar to a disc hernia,<a class="elsevierStyleCrossRefs" href="#bib9"><span class="elsevierStyleSup">9,16</span></a> although without other findings in the physical and neurological evaluation.<a class="elsevierStyleCrossRef" href="#bib17"><span class="elsevierStyleSup">17</span></a> The pain is generally worse during the night and improves with the use of non-hormonal anti-inflammatory drugs.<a class="elsevierStyleCrossRef" href="#bib18"><span class="elsevierStyleSup">18</span></a></p><p id="para30" class="elsevierStylePara elsevierViewall">Scoliosis secondary to pain and muscular spasms<a class="elsevierStyleCrossRef" href="#bib19"><span class="elsevierStyleSup">19</span></a> is a common finding in affected adolescents (63% to 70%). If treatment is delayed, scoliosis may become a complication since the curve may become structured through asymmetric inhibition of the growth of the vertebral epiphysis.<a class="elsevierStyleCrossRefs" href="#bib13"><span class="elsevierStyleSup">13,17,20,21</span></a> The tumor is generally located at the apex of the deformity.<a class="elsevierStyleCrossRefs" href="#bib18"><span class="elsevierStyleSup">18,19</span></a> When the fourth or fifth lumbar vertebra is involved, it is generally associated with pelvic obliquity.<a class="elsevierStyleCrossRef" href="#bib18"><span class="elsevierStyleSup">18</span></a></p><p id="para40" class="elsevierStylePara elsevierViewall">The tumor niche, even when small, can generally be observed by means of scintigraphy with technetium.<a class="elsevierStyleCrossRef" href="#bib22"><span class="elsevierStyleSup">22</span></a> It is possible to identify the lesion on tomographic sections of thickness less than 1.5 centimeters and magnetic resonance images (MRI). Osteoid osteoma is better seen on MRI because of its high signal in the bone around the lesion in sections with T2 weighting, thus demonstrating local edema.<a class="elsevierStyleCrossRef" href="#bib22"><span class="elsevierStyleSup">22</span></a></p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">CASE REPORT</span><p id="para50" class="elsevierStylePara elsevierViewall">A 44-year-old female patient sought orthopedic attendance because of constant lumbar pain that had lasted for two years with progressive worsening. She reported that the pain was more intense at night, but did not worsen with movement or any pain crises during the day. Her pain did not radiate to the lower limbs or other regions. There was no history of trauma, fever, weight loss, or sphincter alterations. She had previously undergone treatment with non-hormonal anti-inflammatory drugs, with improvement only while she was using the medications. On physical evaluation, she had pain on palpation of the fourth lumbar vertebra, without deformity. Neurological and vascular examinations did not present alterations.</p><p id="para60" class="elsevierStylePara elsevierViewall">Radiography of the lumbar spine did not reveal abnormalities. Scintigraphy using Tc<span class="elsevierStyleSup">99m</span> demonstrated increased uptake on the left side of the vertebral body of the fourth vertebra (<a class="elsevierStyleCrossRef" href="#fig1">figure 1</a>). Computed tomography of the lumbar spine revealed an area of hypoattenuation surrounded by an area of hyperattenuation (bone sclerosis), suggestive of an osteogenic tumor (<a class="elsevierStyleCrossRefs" href="#fig2">figures 2 and 3</a>). Complementary examination using MRI demonstrated a signal alteration of 1 cm diameter in the vertebral body of the fourth lumbar vertebra, close to the base of the left pedicle, surrounded by an area of signal compatible with bone edema (<a class="elsevierStyleCrossRefs" href="#fig4">figures 4 and 5</a>). The anamnesis data, physical evaluation, and complementary examinations suggested the presence of osteoid osteoma in the vertical body of the fourth lumbar vertebra.</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><elsevierMultimedia ident="fig2"></elsevierMultimedia><elsevierMultimedia ident="fig3"></elsevierMultimedia><elsevierMultimedia ident="fig4"></elsevierMultimedia><elsevierMultimedia ident="fig5"></elsevierMultimedia><p id="para70" class="elsevierStylePara elsevierViewall">A tomography-guided biopsy was performed, and material was collected for cultures, pathological studies in paraffin, and fast freezing (<span class="elsevierStyleItalic">in print</span>). Pathological study of frozen sections ruled out the presence of neoplastic cells. At the same time, minimally invasive destruction of the tumor was performed through a pedicullar approach, via an Arthrocare® radiofrequency probe set at 80°. The correct positioning of the probe was confirmed with computed tomography (<a class="elsevierStyleCrossRef" href="#fig6">figure 6</a>). The histopathological examination of paraffin sections confirmed the diagnosis of osteoid osteoma (<a class="elsevierStyleCrossRef" href="#fig7">figure 7</a>). There was no bacterial growth in the cultures collected.</p><elsevierMultimedia ident="fig6"></elsevierMultimedia><elsevierMultimedia ident="fig7"></elsevierMultimedia><p id="para80" class="elsevierStylePara elsevierViewall">After the procedure, the patient was allowed to walk with the use of a Putti jacket. The jacket was used for six weeks, and the patient's pain progressively improved. One year after the procedure, computed tomography did not demonstrate any tumor, and the patient did not report any lumbar pain.</p></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">DISCUSSION</span><p id="para90" class="elsevierStylePara elsevierViewall">Osteoid osteoma in the vertebral column is more frequent in young adults (11-22 years)<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a> and is also more common in the posterior elements of the vertebra.<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a> The case in question did not present the typical epidemiology.</p><p id="para100" class="elsevierStylePara elsevierViewall">The natural history of osteoid osteoma demonstrates the possibility of spontaneous cure of the lesion after two to eight years. However, intense pain and the risk of secondary scoliosis<a class="elsevierStyleCrossRef" href="#bib20"><span class="elsevierStyleSup">20</span></a> justify surgical treatment in selected cases. The surgical treatment consists of <span class="elsevierStyleItalic">en-bloc</span> resection to remove the niche and the sclerosis halo.<a class="elsevierStyleCrossRefs" href="#bib10"><span class="elsevierStyleSup">10,23,24</span></a></p><p id="para110" class="elsevierStylePara elsevierViewall">Osteoid osteoma can usually be diagnosed through computed tomography. It demonstrates a radiolucent nidus surrounded by a dense reactive rim of cortical bone which is usually less than 1 centimeter in diameter.<a class="elsevierStyleCrossRef" href="#bib25"><span class="elsevierStyleSup">25</span></a> However, the definitive diagnosis must be made by histopathological examination.<a class="elsevierStyleCrossRef" href="#bib22"><span class="elsevierStyleSup">22</span></a> Biopsy of the lesion and resection of the tumor niche aided by intraoperative computed tomography has been described by several authors.<a class="elsevierStyleCrossRefs" href="#bib26"><span class="elsevierStyleSup">26–28</span></a></p><p id="para120" class="elsevierStylePara elsevierViewall">Radiofrequency ablation was initially described by Rosenthal et al. Recently, it has been successfully used in minimally invasive treatment of osteoid osteoma,<a class="elsevierStyleCrossRefs" href="#bib15"><span class="elsevierStyleSup">15,29–33</span></a> with fewer complications compared to surgical treatment.<a class="elsevierStyleCrossRef" href="#bib15"><span class="elsevierStyleSup">15</span></a> However, the efficacy of this procedure still needs to be analyzed with a larger case series.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "cesec10" "titulo" => "INTRODUCTION" ] 1 => array:2 [ "identificador" => "cesec20" "titulo" => "CASE REPORT" ] 2 => array:2 [ "identificador" => "cesec30" "titulo" => "DISCUSSION" ] 3 => array:1 [ "titulo" => "REFERENCES" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 601 "Ancho" => 870 "Tamanyo" => 29455 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Scintigraphy with the use of Tc 99m demonstrated increased uptake on the left side of the vertebral body of the fourth lumbar vertebra.</p>" ] ] 1 => array:7 [ "identificador" => "fig2" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 627 "Ancho" => 843 "Tamanyo" => 35800 ] ] "descripcion" => array:1 [ "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Computed tomography demonstrating an area of hypoattenuation surrounded by an area of hyperattenuation (bone sclerosis).</p>" ] ] 2 => array:7 [ "identificador" => "fig3" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 757 "Ancho" => 799 "Tamanyo" => 30685 ] ] "descripcion" => array:1 [ "en" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">Tomographic reconstruction demonstrating the tumor niche and adjacent bone sclerosis.</p>" ] ] 3 => array:7 [ "identificador" => "fig4" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 671 "Ancho" => 768 "Tamanyo" => 48996 ] ] "descripcion" => array:1 [ "en" => "<p id="spara40" class="elsevierStyleSimplePara elsevierViewall">Magnetic resonance showing an axial section through the fourth lumbar vertebra in a Tl sequence, demonstrating alteration in the vertebral body at the base of the left pedicle.</p>" ] ] 4 => array:7 [ "identificador" => "fig5" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 905 "Ancho" => 479 "Tamanyo" => 54526 ] ] "descripcion" => array:1 [ "en" => "<p id="spara50" class="elsevierStyleSimplePara elsevierViewall">Magnetic resonance showing a sagittal section through the lumbar column in a T2 sequence, demonstrating the tumor niche and the sclerosis halo.</p>" ] ] 5 => array:7 [ "identificador" => "fig6" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 734 "Ancho" => 862 "Tamanyo" => 40576 ] ] "descripcion" => array:1 [ "en" => "<p id="spara60" class="elsevierStyleSimplePara elsevierViewall">Tomographic image of the minimally invasive transpedicular procedure in the fourth lumbar vertebra.</p>" ] ] 6 => array:7 [ "identificador" => "fig7" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 792 "Ancho" => 997 "Tamanyo" => 158089 ] ] "descripcion" => array:1 [ "en" => "<p id="spara70" class="elsevierStyleSimplePara elsevierViewall">Histological appearance of the material collected from the percutaneous biopsy, processed in paraffin for staining with hematoxylin and eosin. Observe the osteoid osteoma niche and the eosinophilic areas of newly formed bone without a trabecular pattern.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec10" "bibliografiaReferencia" => array:33 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Osteoid-osteoma. A benign osteoblastic tumor of osteoid and atypical bone" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ HL Jaffe \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Surg." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 56 | 16 | 72 |
| 2024 September | 76 | 21 | 97 |
| 2024 August | 57 | 13 | 70 |
| 2024 July | 55 | 15 | 70 |
| 2024 June | 35 | 15 | 50 |
| 2024 May | 36 | 17 | 53 |
| 2024 April | 33 | 9 | 42 |
| 2024 March | 44 | 11 | 55 |
| 2024 February | 52 | 11 | 63 |
| 2024 January | 71 | 8 | 79 |
| 2023 December | 51 | 17 | 68 |
| 2023 November | 48 | 16 | 64 |
| 2023 October | 46 | 21 | 67 |
| 2023 September | 17 | 18 | 35 |
| 2023 August | 2 | 5 | 7 |
| 2023 July | 3 | 10 | 13 |
| 2023 June | 1 | 0 | 1 |
| 2023 April | 1 | 2 | 3 |
| 2023 March | 2 | 1 | 3 |
| 2023 February | 0 | 0 | 0 |
| 2023 January | 1 | 10 | 11 |
| 2022 December | 1 | 4 | 5 |
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