Mid- and long-term clinical results of surgical therapy in unicameral bone cysts

Abstract

BackgroundUnicameral (or simple) bone cysts (UBC) are benign tumours most often located in long bones of children and adolescents. Pathological fractures are common, and due to high recurrence rates, these lesions remain a challenge to treat. Numerous surgical procedures have been proposed, but there is no general consensus of the ideal treatment. The aim of this investigation therefore was to study the long-term outcome after surgical treatment in UBC.MethodsA retrospective analysis of 46 patients surgically treated for UBC was performed for short and mid-term outcome. Clinical and radiological outcome parameters were studied according to a modified Neer classification system. Long-term clinical information was retrieved via a questionnaire at a minimum follow-up of 10 years after surgery.ResultsForty-six patients (17 female, 29 male) with a mean age of 10.0 ± 4.8 years and with histopathologically confirmed diagnosis of UBC were included. Pathological fractures were observed in 21 cases (46%). All patients underwent surgery for UBC (35 patients underwent curettage and bone grafting as a primary therapy, 4 curettage alone, 3 received corticoid instillation and 4 decompression by cannulated screws). Overall recurrence rate after the first surgical treatment was 39% (18/46), second (17.4% of all patients) and third recurrence (4.3%) were frequently observed and were addressed by revision surgery. Recurrence was significantly higher in young and in male patients as well as in active cysts. After a mean of 52 months, 40 out of 46 cysts were considered healed. Prognosis was significantly better when recurrence was observed later than 30 months after therapy. After a mean follow-up of 15.5 ± 6.2 years, 40 patients acknowledged clinically excellent results, while five reported mild and casual pain. Only one patient reported a mild limitation of range of motion.ConclusionsOur results suggest satisfactory overall long-term outcome for the surgical treatment of UBC, although short-and mid-term observation show a considerable rate of recurrence independent of the surgical technique.

Factors predictive of positive response to steroid therapy in simple bone cysts: an old trick that still works

“…During the drilling, care was taken to connect all the separate cavities of the lesion. In general, the methylprednisolone dose was slightly lower than the one reported by Scaglietti et al, reaching a maximum level of 140 mg per procedure (mean 80.01 mg) depending on the weight and age of the child and the size of the cyst, which is in accordance with other authors [6,24]. Also the time to treatment initiation in our study-1.5-3 months from the diagnosis or pathological fracture-corresponds to figures presented in the pertinent literature [6,22].…”

Triple methylprednisolone injections for simple humerus cysts at one-month intervals

“…Mean age was 7.8 years (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Eleven cysts (29%) were active and 27 (71%) were latent.…”

“…The most common locations are proximal humerus and proximal femur (4) . The incidence in male children is higher than in female children (5) . They comprise 3% of bone-sourced tumors (5) .…”

“…The incidence in male children is higher than in female children (5) . They comprise 3% of bone-sourced tumors (5) . Simple bone cysts were described for the first time in 1876 by Virchow (6) .…”

Treatment of Unicameral Bone Cysts: A Comparison on the Use of Steroid Injection and Open Surgery

“…Hastaların çoğu patolojik kırıkla ortopedik cerraha başvurur. Radyolojik muayenede konsantrik yerleşimli, sınırları belirgin, hafif ekspanse ve korteksi incelten ünika-meral veya mültiloküler litik lezyon görülür (5). Basit kemik kistlerinde tedavi patolojik kırık, impending kırık veya semptomatik lezyonların varlığında endikedir.…”