Cone beam computed tomography navigation reduces impact of poor prognostic factors in osteoid osteoma radiofrequency ablation

Background: Osteoid osteoma often requires surgical intervention following conservative treatment failure. While traditional radiofrequency ablation (RFA) is effective, poor prognostic factors such as tumor size, anatomical location, patient age, sex, and previous interventions may negatively influence outcomes. Cone Beam Computed Tomography (CBCT)-navigated RFA could mitigate these negative predictors by enhancing procedural accuracy; however, its specific impact on these factors remains under-investigated. Methods: This retrospective study included 127 patients (median age 20, IQR: 16–25) undergoing CBCT-navigated RFA for osteoid osteomas from 2015 to 2021. Outcomes assessed were treatment failure, recurrence rates, pain relief (Visual Analog Scale [VAS]), functional improvement (Eastern Cooperative Oncology Group [ECOG] status), and postoperative complications classified by the Society of Interventional Radiology (SIR) criteria. Multivariate logistic regression and statistical analyses were conducted to evaluate the influence of previously identified poor prognostic factors on outcomes. Results: Significant long-term pain relief occurred in 97 % of patients, with median VAS scores improving from 9 to 0 postoperatively (p < 0.01). Median ECOG scores improved significantly from 1 to 0 (p < 0.01). Overall treatment failure was observed in 11(8.7 %) patients, including symptomatic recurrence (4, 3.1 %), minor peripheral nerve complaints (3, 2.36 %), limited range of motion (3, 2.36 %), and Metatarsal Fracture (1, 0.8 %). Adult age was the only factor significantly associated with treatment failure (OR = 1.117, p = 0.036), whereas tumor size, anatomical location, biological sex, and prior interventions showed no significant associations. Conclusions: CBCT-navigated RFA effectively reduces the negative impact of traditionally poor prognostic factors, achieving high success rates with minimal complications. While older age remains a modest predictor of poorer outcomes, the absence of significant associations with other previously identified risk factors underscores the enhanced precision and clinical value of CBCT navigation.