Surgical treatment for osteoid osteoma --- experience in both conventional open excision and CT-guided mini-incision surgery.

BACKGROUND Conventional open excision, or en bloc excision, was the standard treatment for osteoid osteoma until the development of percutaneous treatment for this tumor in the early 1990s. Most percutaneous treatments were performed under the guidance of computed tomography (CT), which could clearly demonstrate the exact location of the tumor and minimize bone destruction or resection. In order to minimize bone resection without adding to the costs of these new percutaneous instruments, we modified the percutaneous technique into a CT-guided mini-incision surgery. The patients treated with this technique were compared with those treated by conventional open excision. METHODS We retrospectively reviewed the medical charts of patients with osteoid osteoma treated between 1990 and 2004. The patients diagnosed before 2000 were all treated with conventional open excision. After 2000, some of them were treated with CT-guided mini-incision surgery. Follow-up was done either by phone or on an outpatient basis. RESULTS There were 23 patients with osteoid osteoma who were treated surgically between 1990 and 2004, of whom 20 were treated with conventional open excision. Six patients were treated with CT-guided mini-incision surgery, including 3 primary cases and 3 patients who had previously been treated with conventional open excision (2 recurrent cases and 1 with incomplete excision). The patients treated with CT-guided mini-incision surgery had smaller bone defects, shorter surgical time, and shorter hospital stay. The rate of recurrence or incomplete excision was 23% for conventional surgery and 0% for mini-incision surgery. CONCLUSION CT-guided mini-incision surgery is effective in treating primary as well as recurrent osteoid osteoma.