Osteoid osteoma: percutaneous resection with CT guidance.

In 24 patients with presumed osteoid osteoma in the appendicular skeleton (n = 23) and lumbar spine (n = 1), percutaneous resection with a drill system and computed tomographic (CT) guidance was performed. In the procedure, a 7-mm-diameter toothed drill inserted over a guide wire is used to remove the nidus. Twenty-three patients were successfully treated. Histologic confirmation of osteoid osteoma was obtained in 19 cases. In one patient, open surgery with bone grafting and osteosynthesis was necessary because of inadvertent extensive bone resection resulting from damage to the drill. All patients have remained free of pain and recurrence for 3-24 months. Although the procedure was effective in all patients, the 7-mm diameter of the toothed drill may cause difficulty in small bones or even danger in areas such as the posterior vertebral arch. In locations such as the tubular bones of the lower extremity and the femoral neck, however, this technique is feasible and may become the treatment of choice for osteoid osteoma.