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      Motion preservation surgery: excision of juxta C5–C6 intervertebral disc osteoid osteoma using 3D C-arm based navigation: technical report

      1 , 2 , * , 1
      EDP Sciences
      Osteoid osteoma, 3D Navigation, Minimally invasive, Preserved motion segment, Cervical spine, Spine surgery, Excision.

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          Introduction: Precise targeted excision of the C5–C6 osteoid osteoma with placement of reference array on clavicle with minimal disturbance of anatomy and motion.

          Methods: A 20-year-old male presented with an osteoid osteoma in the superior end plate of the C6 vertebra abutting the spinal canal causing intractable pain. The authors curetted the nidus using a 3D C-arm-based intraoperative scan integrated with an optical navigation system through a minimal access anterior cervical exposure. The patient reference array was affixed to the left clavicle using a threaded pin.

          Results: The postoperative CT-scan revealed complete excision. Follow-up MRI and CT after 12 months revealed C5–C6 intervertebral disc to be intact without evidence of any tumor recurrence. VAS for neck pain improved from 8/10 to 2/10 immediately postoperatively and 0/10 at 1 year follow-up with no limitation of cervical movement. A motion segment was preserved with this technique.

          Conclusions: Navigation allowed safe curettage of the nidus with minimal disturbance to the anatomy and motion. The site of attachment of patient reference array on clavicle can be recommended as stable, meeting all the criteria for optimal accuracy and stability.

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          Most cited references20

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          Medical management compared with operative treatment for osteoid-osteoma.

          Twenty-four patients were evaluated and diagnosed, between August 1975 and July 1989, as having probable osteoid-osteoma. Fifteen patients had operative treatment (twelve immediate and three delayed); all fifteen had complete relief of pain. The remaining nine patients were treated with non-steroidal anti-inflammatory medications; all nine had complete relief of pain, and six had resolution of the symptoms without using non-steroidal anti-inflammatory drugs, after an average of thirty-three months (range, thirty to forty months) of treatment. Thus, long-term administration of non-steroidal anti-inflammatory drugs can often be as effective as excision for the treatment of osteoid-osteoma, without the morbidity that is associated with the operation, especially in patients in whom operative treatment would be complex or might lead to disability.
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            Osteoid osteoma: clinical results with thermocoagulation.

            To determine the clinical results in an unselected group of consecutive patients with osteoid osteoma treated with thermocoagulation. In 97 consecutive patients with clinical and/or radiologic evidence of osteoid osteoma at any location, the clinical symptoms were assessed before and after thermocoagulation with computed tomographic guidance. A good response was defined as disappearance of symptoms that were manifested at presentation and attributed to osteoid osteoma. Clinical assessment was performed prior to discharge; within 2 weeks after the procedure; and at 3, 6, 12, and 24 months follow-up. After 24 months, a postal questionnaire was used for assessment. The mean clinical follow-up after the only or the last thermocoagulation session was 41 months (range, 5-81 months). Response was good after one session of thermocoagulation in 74 (76%) of 97 patients, and the 95% CI was 68% to 85%. Patients with persistent symptoms did well after repeated thermocoagulation (good response in 10 of 12 patients), but results of repeated thermocoagulation were poor in patients with recurrent symptoms (good response in five of 10). The overall success rate after one or two thermocoagulation procedures combined was 92% (89 of 97 patients), and the 95% CI was 86% to 97%. Complications were observed in two patients. Percutaneous thermocoagulation is a safe and effective method for treatment of osteoid osteoma at any location. Repeated thermocoagulation is successful in patients with persistent symptoms.
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              Osteoid osteoma and osteoblastoma of the spine: experiences with 22 patients.

              Osteoblastomas and osteoid osteomas of the spine are relatively rare bone-forming tumors. Between 1980 and 1999, nine patients with osteoid osteoma and 13 patients with osteoblastoma had surgery for their tumors. Four tumors were in the cervical spine, six tumors were in thoracic spine, 10 tumors were in the lumbar spine, and two tumors were in the sacrum. The average duration between onset of pain and surgery was 16.6 months in 12 patients treated in the 1980s and 8.6 months in 10 patients treated in the 1990s. Seventeen patients had scoliosis. In nine of 10 patients with magnetic resonance imaging scans, high signal intensity areas in the muscles and bone around the lesion were seen. Two of nine patients with osteoid osteoma and nine of 13 patients with osteoblastoma had neurologic disorders before treatment. All patients had open resection of the lesions. Two patients with osteoid osteoma had relapse because of incomplete resection, necessitating a second excision. In 16 of 17 patients with preoperative spinal deformity, the deformity improved during followup. With development of modern imaging techniques, exact surgical planning may become possible; however, in some cases, intraoperative complete resection of the lesion still is difficult.

                Author and article information

                SICOT J
                SICOT J
                EDP Sciences
                5 December 2018
                : 4
                : ( publisher-idID: sicotj/2018/01 )
                : 56
                [1 ] Mumbai Spine Scoliosis & Disc Replacement Centre, Bombay Hospital & Medical Research Center Marine Lines Mumbai 400002 India
                [2 ] Saifee Hospital, Maharishi Karve Marg Charni Road Mumbai India
                Author notes
                [* ]Corresponding author: drarvindspines@ 123456gmail.com
                sicotj180098 10.1051/sicotj/2018052
                © The Authors, published by EDP Sciences, 2018

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 25 August 2018
                : 28 October 2018
                Page count
                Figures: 7, Tables: 0, Equations: 0, References: 20, Pages: 4
                Case Report

                osteoid osteoma,3d navigation,minimally invasive,preserved motion segment,cervical spine,spine surgery,excision.


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