Magnetic resonance-guided focused Ultrasound surgery for treatment of osteoid osteoma: How do we do it?

Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) is an increasingly popular non-invasive technique for treatment of severe pain produced by soft tissue, solid or bone tumours. MRgFUS used targeted thermal ablation technique to control moderate to severe pain. Osteoid osteoma is a small benign, highly vascular tumour, composed of osteoid and woven bone, most commonly affect the appendicular skeleton. Bony spine involvement can produce painful scoliosis, while intra-articular joint involvement can cause irreversible joint damage. Clinical presentation is local bone pain which typically worsen at night and with increased activity. Conventional standard treatment of osteoid osteoma is analgesic or surgical intervention. Under conservative medical treatment, the patient needs to be on long term analgesic, e.g. salicylates, where well-known reported complications include renal tubular acidosis and gastric ulcer. The standard surgical treatment is curettage. However, this carry the risk of bleeding, infection and tissue damage. Minimally invasive radiofrequency ablation (RFA) or cryoablation which are the current treatment of choice also carry the risk of tumour rupture and bleeding. We present a case of severe bone pain from benign bone tumor (osteoid osteoma), successfully treated with noninvasive Magnetic MRgFUS.