Treatment of unicameral bone cyst with demineralized bone matrix

Eleven patients with active unicameral bone cysts were treated primarily with placement of demineralized bone matrix in the cyst by using a two-needle technique and a custom large-bore needle. Cyst healing was rated according to the Neer classification, and the average time of healing was 4.5 months. The demineralized bone matrix demonstrated an ability to obliterate the cyst in nine of 11 patients by using a single injection within 4-5 months, and at 2 years' follow-up, no cysts were deemed active or recurrent.

Autogenic bone marrow injections as a treatment for simple bone cyst

Simple bone cyst (SBC) is a benign fluid-filled cavity found primarily at the proximal ends of long bones in children. Treatments proposed for SBC range from observation to intralesional curettage and bone grafting, which are all associated with uncertainty and complications. Because of these factors, a relatively noninvasive protocol with osteoinductive autogenic bone marrow was instituted. Twelve patients were identified with SBCs. Bone marrow was aspirated from the patient's iliac crests and injected into the cyst cavity. Follow-up ranged from 9 to 57 months. Eight (67%) patients demonstrated substantial healing, two (17%) showed partial healing, and two (17%) did not respond to bone marrow therapy. The advantages suggested by bone marrow injection over the currently practiced methods include a higher success rate with a single injection and earlier healing.

Intraosseous cyst injection

Unicameral and aneurysmal bone cysts are benign lesions, but they often require treatment to prevent pathologic fractures. Percutaneous therapeutic techniques have been developed because they are less aggressive than surgery. A radio-orthopedic consensus is required to choose a percutaneous method rather than a surgical procedure, especially in children.

[Solitary bone cyst: etiology, diagnosis, therapy, clinical and radiologic evaluation of treatment results]

Contemporary views on etiology and treatment for solitary bone cyst are presented. Coehn theory of metaphyseal blood flow disturbances as the cause of solitary cyst formation has been emphasized. Minimally invasive treatment modalities have been honored as steroid or autogenous marrow injections into the cyst. Campannaci classification, the most versatile one, embracing various types of cyst remodeling after treatment has been introduced in Polish literature for the first time.

[Pneumocysts juxta-articular to the ilial bone and the sacral bone]

PURPOSE

The purpose of the study was to detect and safely diagnose pneumatocysts by means of computed tomography.

METHODS

From September 1995 to May 1996 computed tomography of the pelvis was performed in six patients for various indications. A slice thickness of 8 mm was employed for all studies. One patient had undergone surgery for hyperparathyroidism nine years previously. Attenuation values within the coincidentally diagnosed pneumatocysts were obtained.

RESULTS

We found a total of 14 pneumatocysts juxtaarticular to the sacroiliac joint. Three patients demonstrated a bilateral intraarticular vacuum phenomenon, yet a joint communication was not found. The lesions did not coincide with inflammation, tumour or trauma.

CONCLUSION

Pneumatocysts are benign bone lesions associated with arthrotic changes of the sacroiliac joint. Computed tomography is the modality of choice for the diagnosis of pneumatocysts.

Ewing's sarcoma presenting as a solitary bone cyst

This report describes a rare case of Ewing's sarcoma presenting as a cystic lesion in the proximal humeral metaphysis. The clinical, pathological and radiological findings are described and discussed, with emphasis on the radiological appearances.

Spinal echinococcal cyst: treatment using computerized tomography-guided needle aspiration and hypertonic saline irrigation. Case report

A multilocular extradural cervical spinal hydatid cyst that causes severe spinal cord compression and quadriplegia is relatively rare and difficult to treat. In a patient with this disorder, computerized tomography-guided needle aspiration of the cyst loculations and irrigation using hypertonic saline eliminated the need for emergency surgery and provided complete resolution of the patient's quadriplegia. The subsequent course of the disease was controlled by treatment with albendazole. Magnetic resonance imaging performed 4 months after the procedure demonstrated collapsed cysts and absence of spinal cord compression.

Unicameral and aneurysmal bone cysts

Unicameral and aneurysmal bone cysts are considered tumorlike conditions of unclear origin. The diagnosis of unicameral bone cysts is almost always based on the radiographic appearance, whereas aneurysmal bone cyst imaging may sometimes mimic a sarcomatous lesion. Several pathogenetic hypotheses [correction of hypothesis] reported in literature have been described. Classifications have been proposed to detect the activity of the cysts and to predict the prognostic behavior. The results observed with different options of treatment have been discussed.

The choice of treatment for simple bone cysts of the upper third of the femur in children

A retrospective study of a series is presented of 19 simple cysts of the upper third of the femur in children of a mean age of 7 years. The patients included 4 adolescents and 15 children under the age of 10. Mean recurrence was 6 years. Different treatment methods were utilized: - surgical treatment: curettage-bone grafting with or without osteosynthesis, - intra-cystic corticoid injection, - orthopedic treatment. Cysts may be small with a low lytic potential, in this case intra-cystic corticoid injections are very effective; or bigger in size with a risk of fracture or have already caused a fracture, the treatment is then surgical but should always be combined with osteosynthesis.

Comparison of cystic rheumatoid arthritis and erosive rheumatoid arthritis

OBJECTIVE

To test the hypothesis that cystic rheumatoid arthritis (RA), characterized as subchondral cysts as the only radiographic abnormality in hands and feet for 2 years after first abnormal radiograph, is a mild subset of RA.

METHODS

Fifty-four patients with cystic RA were compared with 144 RA controls matched for age, sex, disease duration, and year of first visit. All patients were randomly selected from a database of 1580 patients with RA attending the clinic 1982-88. In 1994, data of 90% of the patients were collected by one investigator, blinded to the study groups. All available radiographs were scored for erosions and cysts by one radiologist.

RESULTS

During 17 years of followup (range 2-48 yrs), the cystic RA group had less severe disease. There were fewer disease modifying antirheumatic drug prescriptions and fewer orthopedic operations in the group with cystic RA. The proportion of Rose-Waaler seropositives and the proportion of patients with extraarticular manifestations were the same for both groups. At final assessment, the median Health Assessment Questionnaire score was significantly lower for the group with cystic RA (0,88 vs 1,56; p <0.01). The final radiographic score was significantly lower for the cystic RA group (0,22 vs 0,58; p <0.01). The outcome differences remained after correcting for early radiographic score, rheumatoid factor, early erythrocyte sedimentation rate (ESR), and presence of comorbidity in a multiple regression model. Mortality was the same for both groups.

CONCLUSION

Cystic RA is a relatively mild subset of RA.

Synovial cysts and ganglia: the value of magnetic resonance imaging

Synovial and ganglion cysts commonly present in close proximity to joints and skeletal structures in rheumatic disorders. Familiarity with the presentation of these soft tissue masses can facilitate timely diagnosis and effective management, thus avoiding costly and potentially high-risk procedures to patients. Management usually consists of local, nonsurgical approaches. A patient with chronic joint deformities and clinical features primarily consistent with mixed connective tissue disease is described. Multiple localized masses developed at her right elbow and were identified on T2-weighted magnetic resonance imaging as multiloculated cysts that dissected from the elbow joint. The cysts were treated successfully by needle aspiration and intraarticular corticosteroid injection. The clinical associations, diagnosis, treatment, and management of synovial cysts and ganglions are reviewed.

Pathological fractures secondary to unicameral bone cysts

We carried out a retrospective review of 75 children with unicameral bone cysts, who had sustained 52 pathological fractures, to determine which cysts were likely to be at risk and whether healing was accelerated after a fracture. Most lesions were in the metaphysis of a tubular bone, the commonest sites being the the upper part of the humerus and femur. The percentage of bone occupied by the cyst in the transverse plane was more than 85% in both anteroposterior and lateral radiographs in every case of pathological fracture. In most cases, the cyst recurred and sometimes became large without any acceleration of healing.

Packing with high-porosity hydroxyapatite cubes alone for the treatment of simple bone cyst

In 23 patients, simple bone cysts were treated by curettage followed by packing the cavity with cubes of high-porosity hydroxyapatite (HA). In 22 patients, HA was packed exclusively without autogeneic bone graft. Except in one patient who sustained pathologic fracture at the femoral diaphysis, HA was packed with a fibula strut graft. Each case had an uneventful postoperative course and was followed, on average, two years. Complete healing without cyst recurrence occurred in 18 cases (78%). In three cases--all rapidly growing children--a new cyst appeared between the epiphyseal plate and the HA packing, but the original cysts did not recur. In two multiloculated cysts, the cavities were not filled fully and healing was incomplete, yet there was no cyst recurrence. In the entire group, new bone surrounding HA was roentgenographically evident within an average of 2.3 months. Thus, the result of packing high-porosity HA for simple bone cysts compares favorably with the cure rates reported either with autogeneic bone graft, or topical steroid injection.

Direct Ethibloc injection in benign bone cysts: preliminary report on four patients

Benign bone cysts often require treatment in order to prevent pathological fracture. We report preliminary experience with percutaneous injection of Ethibloc in four children (8-15 years old) presenting with benign bone cysts: two were aneurysmal bone cysts, two were unicameral bone cysts. All the patients were followed up for 12-18 months. Healing was satisfactory in all cases and no complications occurred.

Selective arterial embolization in the treatment of aneurysmal bone cyst and angioma of bone

Nineteen aneurysmal bone cysts and five angiomas of bone were treated by selective arterial embolization. The median follow-up was 22 months. In 17 patients healing occurred with complete relief of symptoms; in 11 of these almost complete ossification of the lesion resulted. In the remaining cases, little or no ossification was apparent but ossification may take 1 year or more to occur. No recurrence was observed in any of these cases. Recurrence occurred only in two cases. In one, growth of the recurrence stopped after a second embolization, and the X-rays showed no change. Selective arterial embolization represents a treatment of choice in aneurysmal bone cyst and angioma of bone especially of the spine, sacrum, or pelvis. In these sites embolization replaces surgery which might be hazardous due to intraoperative bleeding.

Benign tumors of the cervical spine

Benign tumors of the cervical spine are relatively infrequent but have a number of common characteristics that aid in the evaluation and treatment of these lesions. The tumors are most common in the first and second decades of life, presenting as pain, neck stiffness and torticollis. In approximately 70%, the lesions are visible on plain roentgenograms and the remainder are well visualized on bone scan and computed tomographic scan. The majority are present in the posterior elements and may be treated adequately with excisional biopsy by curettage. Stage 3 lesions are best treated by marginal excisional techniques and may require adjunctive techniques such as embolization or radiation therapy. The location of the lesion and extent of excision determine the necessity for fusion.

Aneurysmal bone cyst. A clinicopathologic study of 238 cases

Aneurysmal bone cyst (ABC) is a nonneoplastic expansile bone lesion that mainly affects children and young adults. Primary ABC is relatively rare, with an incidence one half that of giant cell tumor of bone. In 238 patients with ABC studied in the Mayo Clinic files, more than 80% of the lesions were in long bones, flat bones, or the spinal column. Of the lesions initially treated at the Mayo Clinic, 95% were typical ABC; the rest were "solid" variants. Except for the absence of obvious cavernous channels and spaces, there was no significant histologic difference between solid variant and typical ABC. Radiographically, ABC is an eccentric expansile lesion commonly located at the metaphysis of long bones. Computed tomography and magnetic resonance imaging may show multiple internal septations or fluid levels. In the 153 patients treated, 19% had recurrence after curettage (intralesional excision). Recurrence was most common during the first 2 postoperative years.