Introduction

CT guided percutaneous radiofrequency thermo coagulation is the treatment of choice for osteoid osteomas. Good results with a low complication rate have been shown for spinal lesions. When lesions are within close proximity to neurological structures or if patients have radicular symptoms surgery rather than radiofrequency ablation has been advocated. We present our experience of radiofrequency ablation of spinal osteoid osteomas which are less than 5mm from neurological structures, including those causing radicular symptoms.

CT guided percutaneous radiofrequency thermocoagulation is the treatment of choice for osteoid osteomas. Good results with a low complication rate have been shown for spinal lesions. When lesions are within close proximity to neurological structures or if patients have radicular symptoms surgery rather than radiofrequency ablation has been advocated. We present our experience of radiofrequency ablation of spinal osteoid osteomas which are less than 5mm from neurological structures, including those causing radicular symptoms.

Data was collected prospectively on all patients with a spinal osteoid osteoma within 5mm of nerve roots or the spinal cord as measured on CT scanning.

There were nine patients, five female and four male with a mean age of 15 years. Four tumours were located in the thoracic spine, three in the lumbar spine and two in the cervical spine. The mean distance to the nearest neurological structure was 3mm. Radicular symptoms were present in two patients. The mean number of probe positions used was two. Lesions were heated to 90 degrees for 5 minutes for each probe position. There were two cases of recurrence, both treated successfully with one further procedure each. There were no cases of neurological injury. The two patients with radicular symptoms had full resolution of their symptoms. At a mean follow up of 2 years following treatment all patients are asymptomatic.

Radiofrequency ablation can be safely performed to treat osteoid osteomas located within 5mm of neurological structures and has a low rate of recurrence.

Endoprosthetic replacement is often the preferred treatment for neoplastic lesions as internal fixation has been shown to have a high failure rate. Due to anatomical location, disease factors and patient factors internal fixation may be the treatment of choice. No reports exist in the literature regarding the use of locking plates in the management of neoplastic long bone lesions.

Data was collected prospectively on the first 10 patients who underwent locking plate fixation of neoplastic long bone lesions. Data was collected on the nature of the lesion, surgery performed, complications and outcome.

The patients mean age was 56.6 (15–88). Six lesions were metastatic, one haematological (myeloma) and 3 were primary bone lesions (lymphoma, Giant cell tumour, simple bone cyst). In nine cases a fracture through the lesion had occurred. Anatomical locations of the lesions were; proximal humerus (four), proximal tibia (three), distal femur (two) and distal tibia (one). Cement augmentation of significant bone defects was necessary in seven cases.

The mean hospital stay was 8 days (3–20). There were no inpatient complications. Five patients received adjuvant radiotherapy and one patient received neo-adjuvant radiotherapy to the lesion. There have been 3 deaths. All were due to metastatic disease and occurred between 6 and 12 months after surgery. The mean follow up in the surviving patients is currently 9 months (5–16). There have been no fixation related complications. Patients who had suffered a fracture had restoration of their WHO performance status. At last follow up the mean MSTS was 78% (57–90) for lower limb surgery and 70% (63–76) for upper limb surgery. These figures compare favourably with the results of endoprosthetic replacement.

The early results of locking plate fixation for neoplastic long bone lesions are excellent. Follow up continues to observe how these devices perform in the long term.

Proximal femoral replacement gives reliable relief of pain and return to function in proximal femoral metastases. However, there can be technical problems with reattachment of muscles and tendons to the prosthesis, inadequate reattachment can lead to loss of function and joint stability.

We were keen to establish how effective our current method of abductor reattachment was. All the post operative x-rays of patients who had undergone Stanmore Mets Proximal Femoral Replacement, over the last 2 years at the Royal Shrewsbury and Robert Jones and Agnes Hunt Orthopaedic Hospitals, were reviewed. Particular note was made of the position of the trochanteric osteotomy, whether it remained attached or not to the prosthesis.

The Stanmore Mets Proximal Femoral Replacement has a plate which secures the trochanteric osteotomy to the prosthesis. Two screws go through the plate, osteotomy and into the prosthesis..

There were six patients, 4 male and 2 female with a mean age of 67 years. The primary carcinomas included 2 breast, 2 prostate and 1 lung and 1 renal. In five of the six patients the trochanters became detached. In 3 of the 5 patients the trochanter became detached in the first post operative week and by 2 months all 5 trochanters were detached.

We have since changed our method of attachment of the trochanteric osteotomy to the prosthesis to a hooked trochanteric plate. The plate is attached to the prosthesis by wires. Short term follow up of five patients have shown that all the trochanters have remained all attached.