Skeletal Bone

Osteoid osteoma is a benign tumor of the bone. This tumor is most frequently found in the legs but may occur also at other bones in nearly any part of the body. Osteoid osteoma is a tumor of children and young adults; it is very rare in older adults over the age of 50.

An osteoid osteoma is often diagnosed when it causes pain. The pain is frequently in the night, and patients sometimes wake up from the pain. The pain may also occur during the day. Sometimes the pain gets worse over time. It may be dull or sharp, and gets worse with activity. Typically, patients have relief of their pain with aspirin, ibuprofen or other anti-inflammatory agents.

There may be a lot of inflammation around the tumor and the soft tissue around the tumor may be painful or swollen. Sometimes a lump may even be felt.

When these tumors are imaged, X-rays show new bone formation and sometimes a small spot that is very distinct from the surrounding bone, the nidus. Cat scans (CT) are even better able to show the new bone formation and the nidus.

The most significant symptom of osteoid osteoma is pain. This can be treated with aspirin, ibuprofen or other anti-inflammatory drugs. However, it should be considered that stomach ulcers, heartburn, and bleeding problems may develop from the overuse of anti-inflammatory medications.

For successful and permanent reduction of pain, the tumor must be completely removed. Some surgeries are quite extensive and require large bone grafts and a long recovery period. The method recommended by our interventional radiologists is thermal ablation. During this procedure the tumor is heated or frozen for a few minutes, and thus ablated. This procedure is done on an outpatient basis and has a short recovery time. Though this procedure is minimally invasive, it is still an operative procedure, and is thus often done under general anesthesia. If anesthesia is used, expect to still be discharged the same day, but do not do any strenuous activities.

You will most likely be sedated for the ablation of your osteoid osteoma. Recovery from the anesthesia is usually quite brief, so expect same-day discharge from the hospital to home. Driving and operating heavy machinery are not recommended within the first 24 hours after anesthesia. Nausea following anesthesia is also normal, and you may return to your normal diet if nausea does not occur. If you are on blood thinners, ask for specific instructions on how/when to resume them.

Some patients will experience discomfort after the procedure. We will assess your needs and recommend medications when you are discharged. Depending on where your osteoid osteoma was located, we will give you instructions on any limitations during recovery. Many patient will gradually return to prior activity level over a week or two.

We will see you for a post op visit approximately 2 weeks after the procedure. We will ask you to call us if the symptoms you had prior to the procedure return. There is usually no need for additional imaging unless symptoms return.

Cement Augmentation is a procedure used to treat painful vertebral compression fractures in the spinal column, which are a common result of osteoporosis. The doctor uses imaging guidance to inject a cement mixture into the fractured bone. Following cement augmentation, about 75 percent of patients regain lost mobility and become more active.

When a vertebra breaks or fractures, bone fragments develop. Pain occurs when these fragments slide or rub against each other or protrude into the spinal cord. Cement augmentation involves injecting the bone with a cement mixture to fuse the fragments, strengthen the vertebra and provide pain relief. First, the skin is numbed with a local anesthetic. Then, using imaging guidance, the hollow needle or trocar is passed through the skin into the vertebral body for injection of the cement mixture into the vertebra.

This procedure is performed in the radiology department at Sacred Heart Medical Center. It is normally an outpatient procedure with patient admission in the morning and discharge home in the afternoon. Most cement augmentations take about an hour, occasionally longer.

On the day of the procedure, you should be able to take your usual medications with sips of water or clear liquid up to six hours before the procedure. You should avoid drinking juice, cream and milk. Other than medications, you will be instructed to not eat or drink anything after midnight before your procedure. You should plan to have a relative or friend drive you home after your procedure.

Devices to monitor your heart rate and blood pressure will be attached to your body. You will be positioned lying face down for the procedure. The area through which the hollow needle, or trocar, will be inserted will be shaved, sterilized with a cleaning solution and covered with a surgical drape. Most of the sensation is at the skin incision site, which is numbed using local anesthetic. You may feel pressure when the catheter is inserted.

If the procedure is done with sedation, the intravenous (IV) sedative will make you feel relaxed, sleepy and comfortable for the procedure. You may or may not remain awake, depending on how deeply you are sedated. The treatment area of your back will be cleaned, shaved and numbed. During the procedure you will be asked questions related to your comfort. It is important for you to be able to tell your doctor whether you are feeling any pain. The longest part of cement augmentation procedure involves setting up the equipment and making sure the needle is perfectly positioned in the collapsed vertebral body. A local anesthetic is then injected into the skin and deep tissues, near the fracture. A very small skin incision is made at the site.

Using x‐ray guidance, the trocar is passed through the spinal muscles until its tip is precisely positioned within the fractured vertebra. The orthopedic cement is then injected. Medical‐grade cement hardens quickly, typically within 20 minutes. The trocar is removed after the cement is injected. Pressure will be applied to prevent any bleeding and the opening in the skin is covered with a bandage. No sutures are needed. You may feel a tapping sensation during the procedure as the trocar is advanced into the bone.

You may not drive after the procedure. You will be advised to increase your activity gradually and resume all your regular medications. At home, patients may return to their normal daily activities, although strenuous exertion,such as heavy lifting,should be avoided for at leastsix weeks. If you take blood thinners, check with your doctor about restarting this medication the day after your procedure.

Pain relief isimmediate forsome patients. In others, pain is eliminated or reduced within two days. Pain resulting from the procedure will typically diminish within two to three days. For two or three days afterward, you may feel a bit sore at the point of the needle insertion. You can use an icepack to relieve any discomfort but be sure to protect your skin from the ice with a cloth and ice the area for only 15 minutes per hour. Your bandage should remain in place for 48 hours. Do not immerse the bandage in water for 48 hours. This is to prevent infection. Taking showers is allowed.

Risks:

• Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
• A small amount of orthopedic cement can leak out of the vertebral body. This does not usually cause a serious problem, unless the leakage moves into a potentially dangerous location such as the spinal canal or the blood vessels of the lungs.
• Other possible complications include infection, bleeding, increased back pain and neurological symptoms such as numbness or tingling. Paralysis is extremely rare.
• Approximately 10 percent of patients may develop additional compression fractures after cement augmentation. When this occurs, patients usually have relief from the procedure for a few days but develop recurrent pain soon thereafter.
• There is a low risk of allergic reaction to the medications.

Benefits:

• Cement augmentation can increase a patient’s functional abilities and allow return to the previous level of activity without any form of physical therapy or rehabilitation.
• These procedures are usually successful at alleviating the pain caused by a vertebral compression fracture; many patients feel significant relief almost immediately or within a few days. Many patients become symptom‐free.
• Following cement augmentation, about 75 percent of patients regain lost mobility and become more active, which helps combat osteoporosis. After the procedure, patients who had been immobile can get out of bed, and this can help reduce their risk of pneumonia. Increased activity builds more muscle strength, further encouraging mobility.
• No surgical incision is needed—only a small nick in the skin that does not have to be stitched.