Checkup

Getting a Break

Treatment for Benign Bone Tumors Eases chronic Pain

Now that the pain from his osteoid osteoma is gone, Houser and his wife Jessica are able to enjoy more outdoor adventures together.

He doesn't recall exactly how old he was, perhaps 9 or 10, but Matthew Houser remembers his older brother urging him to jump from the top of their basement stairs to the trampoline below.

"He told me I could fly," Houser recalls, "and I believed it."

The unfortunate result was a broken leg, the left fibula, to be exact.

A dozen years after this childhood rite of passage, Houser was working out in the gym when he felt pain in his leg where it had been broken. It took two painful years of unsuccessful treatments and a cancer scare before he was finally diagnosed with an osteoid osteoma. Though these benign bone tumors are rare, they can occur in teens and young adults, and some have suggested that they may result from a traumatic injury, such as a fracture, years earlier.

Houser, now 24, was referred to Dr. Jeffrey Peterson, a radiologist at Mayo Clinic in Jacksonville. Peterson performed a minimally invasive treatment called radiofrequency ablation (RFA) to destroy the tumor in Houser's leg. A few hours later, Houser was walking without pain.

"With many patients, it takes a while to make the diagnosis," Peterson says. "That's because it's a difficult diagnosis to make based on imaging studies alone. So you really have to have the clinical correlation along with the imaging findings."

Once a diagnosis is made, Peterson says, the typical route is to treat patients with nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen or naproxen for six months. A small percentage of patients will feel better and have no pain recurrence. However, most patients will eventually opt for surgery to remove the tumor or RFA to destroy it.

"The problem with surgery is that it can be quite difficult to pinpoint the tumor during the procedure," Peterson says.

Houser (on the slide) and his brother Nick, several years before his trampoline stunt.

Tumors will grow back if they're not totally removed. Because surgeons can't tell exactly where the center of the tumor is, they compensate by removing a large portion of the bone.

"This usually requires significant convalescence afterward," Peterson says. "In some cases that means the patient cannot put weight on the leg for a long time to get the bone to heal. If enough bone has been removed, the patient will be at increased risk of breaking the bone."

Houser was first treated with anti-inflammatory drugs.

"I'd have to take something at night so I could sleep," he says. "After it went on, I had to take something all the time or I couldn't walk."

Before his diagnosis, Houser underwent arthroscopic surgery on his knee, which turned out not to be the source of his pain. Physical therapy and prescription pain medications didn't help. An injection of local anesthetic provided immediate, though temporary, relief. Finally, a bone scan turned up something suspicious in his left tibia, and he was referred to a cancer specialist. He was relieved to find out that it was an osteoid osteoma. He took his doctor's advice and came to Mayo Clinic to have RFA.

"I decided to have it done," Houser says, "because it offered the quickest recovery, and because the doctors who recommended it were supposedly tops in their field. It's a relief that I won't ever have to deal with it again since they got rid of it."

Houser had general anesthesia before the procedure, which took about 90 minutes. Using CT guidance to show the tumor, Peterson inserted a biopsy needle into the center of the bone lesion. The hollow core of the needle provided a shaft through which Peterson introduced an electrode. The power was turned on, and radiofrequency energy radiated out from the electrode, generating heat of 194 degrees Fahrenheit that destroyed the tumor after six minutes.

Houser said he needed no pain medication afterwards. However, some patients may take over-the-counter or prescription pain medication for a few days to dull pain at the puncture site or in the bone.

"The critical portion of the procedure is getting the biopsy needle in the exact center of the lesion," Peterson says. "CT can precisely obtain measurements down to less than one millimeter. So I can easily tell after doing a CT scan exactly where my needle is and where the tip of the electrode is going to be. Even though these are small lesions, CT has the capability of imaging them quite well."

Tumors larger than one centimeter (0.4 inch) in diameter will require repositioning of the biopsy needle and electrode for a second ablation. Peterson does not recommend RFA for tumors that require more than two ablation cycles. And he says tumors close to arteries or veins and those in the spine should not be treated with RFA because of potential heat injury to these vital structures.

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Department of Radiology
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