Percutaneous Treatment of Aneurysmal Bone Cyst With Calcitonin and Methylprednisolone

Abstract

ObjectiveTo introduce the intralesional calcitonin and methylprednisolone percutaneous injection method, which results in the promotion of primary aneurysmal bone cyst (ABC) healing.MethodsA retrospective cohort study involving 76 patients diagnosed with ABC was performed between 2005 and 2014. Patients treated with calcitonin and methylprednisolone injection and who underwent more than 2 years of follow-up were considered eligible for the study (n=47). The Enneking staging and Capanna classification systems were used during the initial evaluation. Treatment response was assessed by Rastogi radiographic grading based on the degree of healing. X2 and Wilcoxon signed-rank tests and odds ratio calculations were used in the statistical analysis with a 5% significance level.ResultsThe proximal tibia extremity was the most commonly affected site (17.0%). Thirty-three (70.3%) ABC cases were staged as B3 and 28 (59.7%) were classified as type II. The average number of injections performed was 2.8 per patient, with an average reduction of the initial lytic area of 83.7% (p-value=0.00001). Satisfactory results for 91.4% (n=43; p-value=0.00001) were obtained and 5 recurrences occurred. No side effects were observed.ConclusionIntralesional calcitonin and methylprednisolone percutaneous injection is a minimally invasive, effective, and safe method for promoting primary ABC healing. Level of evidence IV, Type of study: case series.

Efficacy of treatment interventions for primary aneurysmal bone cysts: a systematic review

“…The most commonly injected substance was Polidocanol (44%); 19 , 46 other substances included Ethibloc (20%), 39 , 45 , 47 - 49 alcohol (14%), 42 calcitonin with methylprednisolone (12%), 43 methylprednisolone alone (1%), 39 doxycycline (4%), 50 and Surgiflo with alcohol (4%). 44 The mean number of injections delivered to patients in each study varied from 1.1 to 6.4, with patients in five studies receiving five or more injections.…”

“… 44 The mean number of injections delivered to patients in each study varied from 1.1 to 6.4, with patients in five studies receiving five or more injections. 19 , 20 , 43 , 46 , 50 Patients receiving doxycycline injections required the greatest number of treatment sessions, ranging between two and 14 injections. 50 The time interval between repeat injections also varied, with one study reporting intervals ranging between 0.2 and 20.1 months.…”

“…Series reporting on fewer than ten patients were excluded to reduce risk of reporting bias, and minimum follow-up was restricted to 12 months to ensure an appropriate length of time was allowed to detect the majority of recurrences. 12 Surgical curettage is reported to be the most commonly implemented treatment for ABCs 2 , 43 and the majority of studies included in this review evaluated curettage with or without some form of adjuvant therapy and grafting. The remaining articles evaluated repetitive injection therapy and failure rates were found to be similar across both groups.…”

“…As a result, several authors have concluded that injection-based therapy is potentially a superior treatment option when considering the invasiveness and complication profile of open surgery. 19 , 20 , 42 , 43 With a predominantly paediatric population being affected, however, we must also consider the considerable burden associated with the multiple general anaesthetics required for most injection therapies. In addition to the disruption this can cause to a child’s life, there is also a risk that repeated general anaesthesia can cause emotional and behavioural disturbances.…”

Reverse shoulder megaprosthesis replacement for aggressive aneurysm bone cyst of proximal humerus: Case report and literature review

“…Radiation therapy with a dose of 30–40 Gy also often encounters complications such as bone necrosis, cancer [ 13 ]. Using Calcitonin and methylprednisolone injected intracystically has been evaluated by some authors as a safe and effective method with a low recurrence rate, helping to promote the healing of primary ABC lesions [ 15 , 16 ]. Recently, the use of doxycycline is also a new option because of its anti-cancer properties, including inhibition of matrix metalloproteinase and angiogenesis, which are two factors that play a role in the development of ABC size in bone [ 17 ].…”