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Minimal invasive surgery for unicameral bone cyst using demineralized bone matrix: a case series.

Cho HS, Seo SH, Park SH, Park JH, Shin DS, Park IH - BMC Musculoskelet Disord (2012)

Bottom Line: Recent concern focuses on the effectiveness of closed methods.The mean time to healing was 6.6 months (range, 3-12 months).Four had incomplete healing radiographically but had no clinical symptom with enough cortical thickness to prevent fracture.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea.

ABSTRACT

Background: Various treatments for unicameral bone cyst have been proposed. Recent concern focuses on the effectiveness of closed methods. This study evaluated the effectiveness of demineralized bone matrix as a graft material after intramedullary decompression for the treatment of unicameral bone cysts.

Methods: Between October 2008 and June 2010, twenty-five patients with a unicameral bone cyst were treated with intramedullary decompression followed by grafting of demineralized bone matrix. There were 21 males and 4 female patients with mean age of 11.1  years (range, 3-19 years). The proximal metaphysis of the humerus was affected in 12 patients, the proximal femur in five, the calcaneum in three, the distal femur in two, the tibia in two, and the radius in one. There were 17 active cysts and 8 latent cysts. Radiologic change was evaluated according to a modified Neer classification. Time to healing was defined as the period required achieving cortical thickening on the anteroposterior and lateral plain radiographs, as well as consolidation of the cyst. The patients were followed up for mean period of 23.9 months (range, 15-36 months).

Results: Nineteen of 25 cysts had completely consolidated after a single procedure. The mean time to healing was 6.6 months (range, 3-12 months). Four had incomplete healing radiographically but had no clinical symptom with enough cortical thickness to prevent fracture. None of these four cysts needed a second intervention until the last follow-up. Two of 25 patients required a second intervention because of cyst recurrence. All of the two had a radiographical healing of cyst after mean of 10 additional months of follow-up.

Conclusions: A minimal invasive technique including the injection of DBM could serve as an excellent treatment method for unicameral bone cysts.

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Insufficient DBM in quantity leaded to inadequate healing of the cyst. Plain radiographs A) of the proximal humerus in a 3-year-old boy B) at postoperative 3 months showing filling defect of DBM C) at postoperative 14 month showing recurrence of cyst D) after repeat intervention E) at 13 additional months of follow-up after a second intervention.
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Figure 4: Insufficient DBM in quantity leaded to inadequate healing of the cyst. Plain radiographs A) of the proximal humerus in a 3-year-old boy B) at postoperative 3 months showing filling defect of DBM C) at postoperative 14 month showing recurrence of cyst D) after repeat intervention E) at 13 additional months of follow-up after a second intervention.

Mentions: Since autologous bone marrow grafting for UBC treatment was introduced by Lokiec in 1996 [31], the injection of bone marrow alone or in combination with DBM has been proposed as an alternative to steroid injection. The injection of bone marrow provides osteoprogenitor cells and DBM could stimulate new bone formation owing to its osteoinductive and osteoconductive properties [5,14,32]. Recently, many authors have evaluated the effectiveness of DBM as a graft substitute and it is applied in many surgical grafting procedures including spinal fusion, joint reconstructive surgery, trauma and oral/maxillofacial surgery. With respect to the use of DBM in UBC treatment, the effectiveness as a graft material after intramedullary decompression has been evaluated by some authors [7,10,11,29,33] Kanellopoulos et al [13] and Rougraff et al [14] reported about 90% success rate after a single procedure using a mixture of DBM and autologous bone marrow and it took six to nine months to achieve cortical remodeling radiographically. In the present study, we had a cumulative success rate of 100%. In addition, the mean time to healing was 6.6 months. In the current study, two cysts required a repeat procedure. In both cases, the amount of DBM injected was not enough to fill the entire cyst (Figure 4). The basic concept of percutaneous procedure is the intramedullary decompression followed by grafting of osteogenic materials. The importance of induction of osteogenesis following intramedullary decompression in UBC treatment has been advocated by several authors. The high recurrence rate of steroid injection was probably caused by absence of osteogenic potential. In this regard, DBM could be a good grafting substitute for UBC treatment after intramedullary decompression owing to its excellent osteogenic property. In addition, it would be desirable to use an adequate amount of DBM to fill the entire cyst. In the case of Figure 3, it seemed that the insufficient DBM in quantity led to inadequate healing of the cyst and eventually cyst recurrence.


Minimal invasive surgery for unicameral bone cyst using demineralized bone matrix: a case series.

Cho HS, Seo SH, Park SH, Park JH, Shin DS, Park IH - BMC Musculoskelet Disord (2012)

Insufficient DBM in quantity leaded to inadequate healing of the cyst. Plain radiographs A) of the proximal humerus in a 3-year-old boy B) at postoperative 3 months showing filling defect of DBM C) at postoperative 14 month showing recurrence of cyst D) after repeat intervention E) at 13 additional months of follow-up after a second intervention.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475132&req=5

Figure 4: Insufficient DBM in quantity leaded to inadequate healing of the cyst. Plain radiographs A) of the proximal humerus in a 3-year-old boy B) at postoperative 3 months showing filling defect of DBM C) at postoperative 14 month showing recurrence of cyst D) after repeat intervention E) at 13 additional months of follow-up after a second intervention.
Mentions: Since autologous bone marrow grafting for UBC treatment was introduced by Lokiec in 1996 [31], the injection of bone marrow alone or in combination with DBM has been proposed as an alternative to steroid injection. The injection of bone marrow provides osteoprogenitor cells and DBM could stimulate new bone formation owing to its osteoinductive and osteoconductive properties [5,14,32]. Recently, many authors have evaluated the effectiveness of DBM as a graft substitute and it is applied in many surgical grafting procedures including spinal fusion, joint reconstructive surgery, trauma and oral/maxillofacial surgery. With respect to the use of DBM in UBC treatment, the effectiveness as a graft material after intramedullary decompression has been evaluated by some authors [7,10,11,29,33] Kanellopoulos et al [13] and Rougraff et al [14] reported about 90% success rate after a single procedure using a mixture of DBM and autologous bone marrow and it took six to nine months to achieve cortical remodeling radiographically. In the present study, we had a cumulative success rate of 100%. In addition, the mean time to healing was 6.6 months. In the current study, two cysts required a repeat procedure. In both cases, the amount of DBM injected was not enough to fill the entire cyst (Figure 4). The basic concept of percutaneous procedure is the intramedullary decompression followed by grafting of osteogenic materials. The importance of induction of osteogenesis following intramedullary decompression in UBC treatment has been advocated by several authors. The high recurrence rate of steroid injection was probably caused by absence of osteogenic potential. In this regard, DBM could be a good grafting substitute for UBC treatment after intramedullary decompression owing to its excellent osteogenic property. In addition, it would be desirable to use an adequate amount of DBM to fill the entire cyst. In the case of Figure 3, it seemed that the insufficient DBM in quantity led to inadequate healing of the cyst and eventually cyst recurrence.

Bottom Line: Recent concern focuses on the effectiveness of closed methods.The mean time to healing was 6.6 months (range, 3-12 months).Four had incomplete healing radiographically but had no clinical symptom with enough cortical thickness to prevent fracture.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea.

ABSTRACT

Background: Various treatments for unicameral bone cyst have been proposed. Recent concern focuses on the effectiveness of closed methods. This study evaluated the effectiveness of demineralized bone matrix as a graft material after intramedullary decompression for the treatment of unicameral bone cysts.

Methods: Between October 2008 and June 2010, twenty-five patients with a unicameral bone cyst were treated with intramedullary decompression followed by grafting of demineralized bone matrix. There were 21 males and 4 female patients with mean age of 11.1  years (range, 3-19 years). The proximal metaphysis of the humerus was affected in 12 patients, the proximal femur in five, the calcaneum in three, the distal femur in two, the tibia in two, and the radius in one. There were 17 active cysts and 8 latent cysts. Radiologic change was evaluated according to a modified Neer classification. Time to healing was defined as the period required achieving cortical thickening on the anteroposterior and lateral plain radiographs, as well as consolidation of the cyst. The patients were followed up for mean period of 23.9 months (range, 15-36 months).

Results: Nineteen of 25 cysts had completely consolidated after a single procedure. The mean time to healing was 6.6 months (range, 3-12 months). Four had incomplete healing radiographically but had no clinical symptom with enough cortical thickness to prevent fracture. None of these four cysts needed a second intervention until the last follow-up. Two of 25 patients required a second intervention because of cyst recurrence. All of the two had a radiographical healing of cyst after mean of 10 additional months of follow-up.

Conclusions: A minimal invasive technique including the injection of DBM could serve as an excellent treatment method for unicameral bone cysts.

Show MeSH
Related in: MedlinePlus