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Mater Misericordiae University Hospital Dublin, Ireland

 
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We thank Dr. Albisinni and colleagues for their letter concerning our article on radiofrequency ablation of osteoid osteoma with cooled probes and impedance-control energy delivery [1]. They describe their experience in osteoid osteoma with a noncooled radiofrequency probe and manual-control energy delivery with a variable duration of more than 18 minutes.

The MR signal change reflecting necrosis with their technique was more than 25 mm [2]. This is beyond the necrosis expected with a low-energy delivery technique. Tillotson et al. [3] describe no increase in ablation beyond 13 mm between 30 seconds and 4 minutes of therapy in bone with a similar electrode.

The short duration of pain after therapy with the described technique reflects the experience in a series with a 6-minute treatment time and 5-mm probe length [4]. Pain in our series after the ablation was worse and persisted longer than with the low-energy technique for ablation, and this may be due to the larger zone of ablation.

In the case of the eccentric osteoid osteoma of the T8 pedicle, the nearest neural structure was 1.5 cm from the active tip. We applied the restriction of 1.5 cm from neural tissue because we were cautious with this technique and probe. We were reassured that the spinal cord may receive protection from therapy by the presence of a heat sink provided by cerebrospinal fluid, spinal venous drainage and the thermal insulation due to thickened cortical bone associated with osteoid osteoma. More data needs to be collected to determine the appropriate selection of candidates for therapy of spinal osteoid osteoma with a high-energy delivery technique.

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1. Cantwell CP, O'Byrne J, Eustace S. Radiofrequency ablation of osteoid osteoma with cooled probes and impedance-control energy delivery. AJR 2006;186 [5 suppl]:S244 –S248[Abstract/Free Full Text]
2. Albisinni U, Ciminari R, Malaguti C, Rimondi E. Radiofrequency ablation of osteoid osteoma. (letter) AJR2007; 188:W578[Free Full Text]
3. Tillotson CL, Rosenberg AE, Rosenthal DI. Controlled thermal injury of bone: report of a percutaneous technique using radiofrequency electrode and generator. Invest Radiol 1989;24 : 888–892[CrossRef][Medline]
4. Barei DP, Moreau G, Scarborough MT, Neel MD. Percutaneous radiofrequency ablation of osteoid osteoma. Clin Orthop 2000; 373:115 –124[CrossRef][Medline]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cantwell, C. P. Articles by O'Byrne, J. Search for Related Content PubMed Articles by Cantwell, C. P. Articles by O'Byrne, J. Social Bookmarking                      What's this?