Treatment of Active Unicameral Bone Cysts With Percutaneous Injection of Demineralized Bone Matrix and Autogenous Bone Marrow

Unicameral bone cysts are benign bone lesions commonly seen in pediatric patients. Several treatment methods have been described with variable results and high recurrence rates. We previously reported short-term success of a minimally invasive technique that includes combining percutaneous decompression and grafting with medical-grade calcium sulfate pellets. The purpose of this study was to review the additional long-term results with a minimum followup of 24 months (average, 37 months; range, 24-70 months). We identified 55 patients with an average age of 10.8 years (range, 1.3-18 years). Forty-one of 55 lesions occurred in the humerus and femur. Fortyfour of 55 (

Section: Discussionmentioning

confidence: 99%

Results of a Minimally Invasive Technique for Treatment of Unicameral Bone Cysts

Mik¹,

Arkader

Manteghi³

et al. 2009

“…Furthermore, one study noted 28% of patients needed another operation because the nail became too short for the growing bone [31]. For other injection techniques, an 18% failure rate has been reported after one DBM injection [21], and failure rates of 11% [19] and 22% [32] have been reported after one injection of DBM plus bone marrow. However, early promising results may later be shown as false; although a 0% failure rate initially was reported after one injection of bone marrow [23], a later study reported a 50% failure rate [42], and a study comparing bone marrow injection with steroids reported failure rates of 57% versus 49%, showing no advantage with bone marrow [5].…”

Section: Discussionmentioning

confidence: 99%

“…Numerous other treatments have been suggested, ranging from subtotal resection [12,25], to flexible intramedullary nailing [9,11,31,33], to placement of Kirschner wires [6,7]. In addition to steroids [4,34], percutaneous injection has been attempted with demineralized bone matrix (DBM) [21], bone marrow [23,42], or a combination of DBM and bone marrow [19,32]. No previous study has examined injection with a combination of steroids, DBM, and bone marrow aspirate (SDB).…”

Section: Introductionmentioning

confidence: 99%

Unicameral Bone Cyst: A Retrospective Study of Three Surgical Treatments

Sung

Anderson

Zurakowski

et al. 2008

100

Between 1979 and 2004, 167 patients younger than 20 years were treated surgically for humeral or femoral unicameral bone cysts with either injection of corticosteroids (steroids), curettage plus bone grafting (curettage), or a combination injection of steroids, demineralized bone matrix, and bone marrow aspirate (SDB) at Children's Hospital of Boston and Massachusetts General Hospital (mean followup, 7.3 years; range, 1 month-27 years). Outcomes included treatment failure (defined clinically as subsequent pathologic fracture or need for retreatment to prevent pathologic fracture) and complications. Information was obtained from medical records and by telephone questionnaire. After one treatment, 84% of cysts treated with steroids experienced failed treatment versus 64% with curettage and 50% with SDB. For unicameral bone cysts requiring retreatment (regardless of first treatment), 76% retreated with steroids had failed treatment versus 63% with curettage and 71% with SDB. Curettage was associated with the lowest rate of posttreatment pathologic fractures and highest rate of pain and other complications. Multivariate logistic regression indicated treatment with steroids alone and younger age were independent predictors of failure. We believe SDB is a reasonable first treatment for unicameral bone cysts in the humerus and femur in patients younger than 20 years, being less invasive yet comparable to curettage in preventing recurrence.

“…One series comparing steroid to bone marrow injection reported a higher number of steroid injections required to achieve the final healing rate [6]. However, despite the differences in the evaluation method, most of the failures occurred within the first two years of followup as reported by other series [11,30], leaving a number of patients in the Neer III grade evaluation to be followed for a long time until evidence of definitive healing was achieved [3,4,27]. When considering factors with a negative effect on the treatment outcome, the humeral site did not score more fractures than other sites [5], although size, younger age and proximity to the growth plate confirmed their negative effect on the final healing rate requiring, despite fracture, a higher number of injections.…”

Section: Volume 468 Number 11 November 2010mentioning

confidence: 99%

“…The injection of bone marrow (BM) alone [5,6,9,21,42,43] or in combination with demineralized bone matrix (DBM) [17,18,29,30,35] has also been proposed as an alternative to steroids for treating UBC. BM should provide osteoprogenitor cells and DBM could stimulate new bone formation thanks to its osteoinductive and osteoconductive properties [20,30].…”

Section: Introductionmentioning

confidence: 99%

Injection of Demineralized Bone Matrix With Bone Marrow Concentrate Improves Healing in Unicameral Bone Cyst

Bella

Dozza

Frisoni

et al. 2010

Background Unicameral bone cysts are benign lesions that usually spontaneously regress with skeletal maturity; however, the high risk of pathologic fractures often justifies treatment that could reinforce a weakened bone cortex. Various treatments have been proposed but there is no consensus regarding the best procedure. Questions/purposes We compared the healing rates and failures of two methods of cure based on multiple injections of corticosteroid or a single injection of demineralized bone matrix (DBM) in association with bone marrow concentrate (BMC). Methods We retrospectively reviewed 184 patients who had one of the two treatments for unicameral bone cysts with cortical erosion. Clinical records were reviewed for treatment failures and radiographs for healing in all patients. The minimum followup was 12 months for the Steroids Group (mean, 48 months; range, 12-120 months) and 12 months for the DBM + BMC Group (mean, 20 months; range, 12-28 months).Results After one treatment we observed a lower healing rate of cysts treated with multiple injections of steroids compared with the healing after the first injection of DBM + BMC (21% versus 58%, respectively). At last followup, 38% healed with steroids and 71% with DBM + BMC. The rate of failure after one steroid injection was higher than after a single injection of BDM + BMC (63% versus 24%, respectively). We observed no difference in fracture rates after treatment between the two groups.