Once osteoblastomas cause symptoms, they must be resected (surgically removed).The challenge in the surgical procedure is hitting the nidus in the bone sclerosis that may be present. The nidus must be completely removed. It is responsible for the pain. The bone sclerosis is left behind.
Damage to muscles, tendons, soft tissues and also nerves located in the surgical access path to the nidus cannot always be excluded.
Caveat: Curettage (excision) is not recommended because it is often associated with recurrence (recurrence of the disease).
CT-guided radiofrequency ablation (RFA)
Meanwhile, CT-guided radiofrequency ablation (RFA) (synonyms: thermal ablation; sclerotherapy) of the nidus is considered a standard therapy and is mainly used for involvement of the dorsal (posterior portions) of the spine. As part of it, a special probe is inserted into the nidus and heated via an alternating current field at the tip. This destroys the prostaglandin-producing cells (prostaglandin = tissue hormone that triggers pain, among other things) in the center and the pain conduction pathways. The procedure is minimally invasive.Another option for heat ablation is laser ablation (LA).
