Rockstar Treatment

It wasn’t fair. Avery Burton’s life was supposed to revolve around high school band practice, teaching karate, and rocking out with his band, “The Blame”. But, the 17-year-old Los Angeles resident feared being sidelined forever when an osteoid osteoma threatened his mobility.

At first, Avery kept the raging hip and knee pain common to this condition to himself.

“I thought maybe I had overworked that area, so I tried massages and soaking. But after the [2007] Coachella Music Festival, where I spent a lot of time jumping up and down, my leg and hip hurt so much that I had trouble sleeping and walking,” he admits.

“The pain soon affected not only my ability to play the drums and do karate, but it also deterred my desire to perform these everyday activities.”

Eventually, the pain became too intense to ignore, and Avery finally informed his parents about his symptoms. Concerned for their son’s wellbeing, they immediately ordered him to seek medical evaluation and treatment. But after undergoing a plethora of tests, Avery was at a standstill. No one could correctly diagnose his condition – and his pain only grew worse.

After weeks of dead-end diagnoses, a family friend encouraged Avery to seek treatment at Los Angeles’ Cedars-Sinai Medical Center. Physicians at the world-renowned facility set up both a bone and CT scan, which revealed a lesion in Avery’s right femur. Finally, the active teen received a definitive diagnosis: osteoid osteoma.

Avery’s physician, Earl Brien, MD, immediately referred him to Thomas J. Learch, MD, an expert in the musculoskeletal radiology field at Cedars-Sinai’s S. Mark Taper Foundation Imaging Center.

Although initially nervous about his condition, Avery says, “Dr. Learch immediately put [my family and me] at ease and told us this particular kind of tumor, while painful, is generally benign. I was finally relieved to have a diagnosis – a name for the pain.”

Still, the thought of undergoing invasive surgery – the traditional method for removing an osteoid osteoma – troubled Avery. Surgery would put him out of commission for three months, meaning his days of karate and drumming would be long gone.

Fortunately, Learch mentioned that Avery could undergo radiofrequency ablation (RFA), an innovative procedure that speeds recovery time while fully treating the tumor.

According to Avery, “Dr. Brien referred me to Dr. Learch because he knew of this new method Dr. Learch was using to remove osteoid osteomas, and found it to be not only the most efficient way to handle my condition, but also the safest.”

Avery’s treatment proved successful, and the busy teen soon resumed his activities.

“After the [RFA procedure], I spent about eight hours in mild pain, and then went to school the very next day … It only took about a week for the pain to completely subside,” he says. “The entire recovery lasted only two weeks, and then my life was back. I was free from the pain that I struggled with for more than six months.”

Today, Avery Burton is known for being more than just a talented athlete and The Blame’s star drummer. Now, he bears the distinction of being the first patient to ever undergo RFA for an osteoid osteoma at Cedars-Sinai – a title which he bears proudly.

Understanding the Condition

Although the likelihood of developing an osteoid osteoma is relatively low, experts still encourage teenagers and young adults to be cognizant of knee pain. Affecting more males than females, these small tumors usually occur in the vertebrae or the long bones, such as the femur.

An osteoid osteoma develops when certain cells divide wildly, forming a small tumor consisting of bone and other tissue. This proliferating tumor then substitutes healthy bone tissue with abnormal, hard bone matter.

Typically, these painful growths fail to evolve or damage the host bone; however, young children with tumors near the growth plate can develop host-bone deformities or larger-than-average-sized bones. If the tumor is located near a joint, swelling or fluid in that joint may also occur.

The following symptoms may indicate the presence of an osteoid osteoma, according to Children’s Hospital Boston:

“In my practice, I probably see a few osteoid osteomas a year,” says Brien, a musculoskeletal tumor specialist at Cedars-Sinai. “They usually occur within the first or second decade of life, so it’s a childhood problem in the majority of cases. In terms of bone tumors, I would say they are uncommon; and in terms of orthopedic conditions, they are extremely rare.”

One problem that arises from osteoid osteoma’s rarity is that these tumors are often misdiagnosed. For instance, Brodie’s abscess – a bone infection usually occurring in the tibia, femur or fibula – is also characterized by intense, localized pain.

Because of this, Brien says, “the critical aspect is to make sure you are making the appropriate diagnosis before treating a lesion percutaneously; because if you treat the wrong lesion, obviously, things could get worse.”

Therefore, he says, it’s imperative that imaging professionals understand the radiological features of both conditions and then refer the patient to an experienced and capable bone specialist.

Henry DeGrott, III, MD, a Mass.-based orthopedic surgeon, for instance, manages a Web site (www.bonetumor.org) to educate healthcare professionals about the various forms of bone tumors. Osteoid osteomas, he remarks, are best detected via CT scanning.

According to DeGrott, “The classic radiological presentation of an osteoid osteoma is a radiolucent nidus surrounded by a dramatic, reactive sclerosis in the cortex of the bone. The center can range from partially mineralized, to osteolytic, to entirely calcified.”

Additionally, he says, the lesion can materialize in the cortex, medulla, or both, and reactive sclerosis may or may not occur. DeGrott cites four diagnostic features of an osteoid osteoma:

Although some evidence has surfaced that osteoid osteomas can be treated with anti-inflammatories alone, many experts remain leery.

“The problem with that is that it usually takes somewhere between two to four years for the lesions to burn out and no longer affect the patient,” Brien says. “That can lead to complications related to anti-inflammatories.”

Fortunately, innovative treatments, such as RFA, are offering osteoid osteoma patients a shorter recovery period and higher quality of life.

The Promise of RFA

A procedure that utilizes radiofrequency energy to destroy tissue, RFA has been employed for the treatment of varicose veins, liver resection, cancer, and more. Although still relatively new – the first radiofrequency tumor ablation was performed in 1996 – medical experts believe that RFA offers patients a noninvasive answer to some traditional surgical treatments.

To Peter Julien, MD, the director of radiofrequency ablation at Cedars-Sinai, RFA is quite possibly the wave of the future. He says, this treatment “offers therapy for patients who had no hope before – because they are often not surgical candidates.”

For instance, he says, “those who had chemotherapy or [those who underwent] radiation therapy and cannot have it again.”

He also cites RFA’s effectiveness for the removal of osteoid osteomas. According to Julien, “[Within an hour of the procedure], these patients – who may be incapacitated with pain on a chronic basis – have gone from intermittent episodes of intense pain to no pain at all.”

However, since osteoid ostomas are fairly rare, Julien says RFA will continue to be marketed for the treatment of more common conditions, such as small cancers.

To perform RFA for osteoid osteoma treatment, the attending physician inserts a wire into the central part of the lesion and thermally ablates it. Brien, a colleague of Julien’s, acknowledges that this process can be quite painful and cumbersome for patients.

“There are pain fibers around the bone, and those patients need to be sedated or asleep during [this] surgical procedure even though it’s minimally invasive,” he says.

One potential detractor that may limit RFA’s utilization, however, is its possibility for recurrence. Brien says that approximately 10 percent of osteoid osteomas resected via RFA return – a relatively high rate.

“Even though you do radiofrequency ablation,” Brien says, “[osteoid osteomas] can reoccur similar to curettage, and they really need to be back in the hands of a clinician who can make the appropriate diagnosis in a timely fashion.”

Still, for patients like Avery Burton, this cutting-edge treatment offers a reprieve from debilitating pain. Embarking on his freshman year at Boston University, Avery feels light years away from the boy who experienced knee pain last year.

Thanks to RFA, Avery feels physically up to par and ready to tackle the challenges college will inevitably bring.

And, he encourages other patients suffering from osteoid osteomas to maintain a positive outlook. “Don’t be afraid,” Avery maintains. “Thanks to modern medicine and innovative research, this condition is very easily taken care of – leaving no trace that the tumor even existed.”

— Keri Forsythe is associate editor of rt image. Questions and comments can be directed to kforsythe@rt-image.com.