Abstract
Study Design: Prospective cohort study.
Objective: To assess the safety and efficacy of an intra-operative gamma probe in the surgical treatment of osteoid osteomas and osteoblastomas arising from the spine.
Summary of background data: Spinal osteoid osteomas and osteoblastomas are difficult to localise and may present adjacent to neural structures. Complete surgical excision of the nidus is a pre-requisite for curative resection.
Methods: All patients with a presumptive diagnosis of osteoid osteoma or osteoblastoma were investigated with plain radiography, computed tomography, magnetic resonance imaging and a technitium bone scan. Nine patients underwent surgical excision. 600 MBq of 99m technitium HMDP was administered intravenously three hours prior to surgery. A sterile cadmium telluride detector connected to a digital counter/ratemeter was used to detect gamma radiation emitted by the tumour intra-operatively to assist with localisation and confirmation of complete excision.
Results: Between October 1995 and September 2006, nine patients required surgical excision for seven osteoid osteomas and two osteoblastomas arising from the spine. All patients were between the ages of 9–31 years and presented with back or neck pain. All tumours involved the posterior elements of the spine. Three patients had previous failed treatment including CT-guided radiofrequency ablation and surgical excision. In all cases the counts per second (cps) dropped significantly following excision. For the osteoid osteoma cases, the mean cps dropped from 203.8 (range 60–515) to 72.5 cps (range 10–220) post-excision. For the osteoblastoma cases the mean cps dropped from 373.5 (range 67–680) to 40.5 cps (range 16–65) post-excision. Histological examination confirmed complete excision in all cases. The mean follow-up was 4.5 years (range 0.5 – 11 years). All patients reported disappearance of the characteristic pre-operative pain.
Conclusions: The use of an intra-operative gamma probe helps to localise and confirm complete excision of osteoid osteoma and osteoblastoma arising from the spine. Accurate localisation results in safe excision with maximal conservation of surrounding normal bone, whilst minimising operative time, blood loss, hospital stay and risk of recurrence.
Correspondence should be addressed to: Mr N. J. Henderson, BASS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
