European Radiology

, Volume 28, Issue 10, pp 4146–4150 | Cite as

Experience of neuroprotective air injection during radiofrequency ablation (RFA) of spinal osteoid osteoma

  • Alessandro VidoniEmail author
  • Melvin Grainger
  • Steven James



To assess the usefulness of epidural air injection during the RFA treatment of spinal osteoid osteoma.


A retrospective review of 17 patients who underwent RFA for spinal osteoid osteoma between September 2006 and May 2017 was performed. All the procedures were performed by a single radiologist. We reviewed the perioperative CT studies to assess the distribution of air relative to the osteoid osteoma. The clinical outcome of each patient group was evaluated during routine follow-up.


Seventeen patients were treated for spinal OO (male:female 13:4; mean age was 16, ranging from 4 to 42). The nidus size ranged from 5.8 to 17.2 mm (mean 11.2). In nine cases epidural air injection was performed. In three cases the neuroprotective air was deemed satisfactory with a clear layer of air between the osteoid osteoma and the dural sac being visualised. In six patients adherence between the cortical bone immediately adjacent to the osteoid osteoma and the dural sac in contact was observed.

In 15 patients the procedure was successful in terms of pain relief. No neural damage or other complication was reported in either group.


RFA is a safe treatment for spinal osteoid osteoma. Neuroprotective air injection does not appear to be necessary when performing the treatment in the spine.

Key Points

• Seventeen patients with spinal OO were treated with RFA, nine with air injection and eight without. Clinically successful treatment was achieved in 15 patients, with 2 subsequently undergoing surgery

• In 6/9 cases the injected air failed to achieve separation between the osteoid osteoma and the thecal sac because of inflammatory adhesion

• No complications were observed, regardless of whether neuroprotective air was instilled. Neuroprotective air injection appears unnecessary when treating spinal OO


Osteoid osteoma Neuroprotection Vertebral column Interventional radiology Tomography 



Osteoid osteoma




Radiofrequency ablation



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Dr Steven James.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was waived by the Institutional Review Board.


• retrospective

• observational

• performed at one institution


  1. 1.
    Rosenthal DI, Springfield DS, Gebhardt MC, Rosemberg AE, Mankin HJ (1995) Osteoid osteoma: percutaneous radio-frequency ablation. Radiology 197:451–454CrossRefGoogle Scholar
  2. 2.
    Motamedi D, Learch TJ, Ishimitsu DN et al (2009) Thermal ablation of osteoid osteoma: overview and step-by-step guide. Radiographics 29:2127–2141CrossRefGoogle Scholar
  3. 3.
    Bourgault C, Vervoort T, Szymanski C, Chastanet P, Maynou C (2014) Percutaneous CT-guided radiofrequency thermocoagulation in the treatment of osteoid osteoma: A 87 patient series. Orthop Traumatol Surg Res 100:323–327CrossRefGoogle Scholar
  4. 4.
    Rosenthal DI, Hornicek FJ, Torriani M, Gebhardt MC, Mankin HJ (2003) Osteoid osteoma: Percutaneous treatment with radiofrequency energy. Radiology 229:171–175CrossRefGoogle Scholar
  5. 5.
    Hoffmann RT, Jakobs TF, Kubisch CH et al (2010) Radiofrequency ablation in the treatment of osteoid osteoma-5-year experience. Eur J Radiol 73:374–379CrossRefGoogle Scholar
  6. 6.
    Gangi AA, Houman Wong L, Buy X, Dietemann J-L, Roy C (2007) Osteoid osteoma: Percutaneous laser ablation and follow-up in 114 patients. Radiology 242:293–301CrossRefGoogle Scholar
  7. 7.
    Albisinni U, Facchini G, Spinnato P, Gasbarrini A, Bazzocchi A (2017) Spinal osteoid osteoma: efficacy and safety of radiofrequency ablation. Skeletal Radiol 46:1087–1094CrossRefGoogle Scholar
  8. 8.
    Rosenthal DI, Hornicek FJ, Wolfe MW, Jennings LC, Gebhardt MC, Mankin HJ (1998) Percutaneous radiofrequency coagulation of osteoid osteoma compared with operative treatment percutaneous radiofrequency coagulation of osteoid osteoma compared with operative treatment. JBJS 80:815–821CrossRefGoogle Scholar
  9. 9.
    Vanderschueren GM, Obermann WR, Dijkstra SPD, Taminiau AHM, Bloem JL, van Erkel AR (2009) Radiofrequency ablation of spinal osteoid osteoma: Clinical outcome. Spine (Phila Pa 1976) 34:901–903CrossRefGoogle Scholar
  10. 10.
    Wang B, Han SB, Jiang L et al (2017) Percutaneous radiofrequency ablation for spinal osteoid osteoma and osteoblastoma. Eur Spine J 26:1884–1892CrossRefGoogle Scholar
  11. 11.
    Rybak LD, Gangi A, Buy X, Vieira RLR, Wittig J (2010) Thermal ablation of spinal osteoid osteomas close to neural elements: Technical considerations. AJR Am J Roentgenol 195:293–298CrossRefGoogle Scholar
  12. 12.
    Klass D, Marshall T, Toms A (2009) CT-guided radiofrequency ablation of spinal osteoid osteomas with concomitant perineural and epidural irrigation for neuroprotection. Eur Radiol 19:2238–2243CrossRefGoogle Scholar
  13. 13.
    Manchikanti L, Malla Y, Wargo BW, Cash KA, Pampati V, Fellows B (2012) A prospective evaluation of complications of 10,000 fluoroscopically directed epidural injections. Pain Physician 15:131–140PubMedGoogle Scholar
  14. 14.
    Noh SH, Heo DH (2015) Whole cerebrospinal axis infection after lumbar epidural injection: a case report. Eur Spine J 24:525–528CrossRefGoogle Scholar
  15. 15.
    Manchikanti L, Kaye A, Hirsch J (2014) The risks of epidural and transforaminal steroid injections in the spine: Commentary and a comprehensive review of the literature. Surg Neurol Int 5:38CrossRefGoogle Scholar
  16. 16.
    Bitsch RG, Rupp R, Bernd L, Ludwig K (2006) Osteoid osteoma in an ex vivo animal model: temperature changes in surrounding soft tissue during CT-guided radiofrequency ablation. Radiology 238:107–112CrossRefGoogle Scholar
  17. 17.
    Nour SG, Aschoff AJ, Mitchell ICS, Emancipator SN, Duerk JL, Lewin JS (2002) Radiology MR imaging-guided radio-frequency thermal ablation of the lumbar vertebrae in porcine models. Radiology 224:452–462CrossRefGoogle Scholar
  18. 18.
    Matsuura Y, Takehira M, Joti Y et al (2015) Thermodynamics of protein denaturation at temperatures over 100 °C: CutA1 mutant proteins substituted with hydrophobic and charged residues. Sci Rep 5:15545CrossRefGoogle Scholar
  19. 19.
    Dupuy DE, Hong R, Oliver B, Goldberg SN (2000) Radiofrequency ablation of spinal tumors. Am J Roentgenol 175:1263–1266CrossRefGoogle Scholar
  20. 20.
    Song AS, Najjar AM, Diller KR (2014) Thermally induced apoptosis, necrosis, and heat shock protein expression in 3D culture. J Biomech Eng 136:71006CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Musculoskeletal RadiologyRoyal Orthopaedic Hospital NHS Foundation TrustBirminghamUK
  2. 2.Spinal Surgical UnitRoyal Orthopaedic Hospital NHS Foundation TrustBirminghamUK

Personalised recommendations