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Apostolopoulos V, Boháč P, Marcián P, Zambo IS, Pazourek L, Mahdal M, Neradil J, Návrat T, Tomáš T. Micro-CT, Mechanical, and Histological Examination of the Effect of Local Adjuvants on Porcine Cortical Bone Following Intralesional Curettage of Bone Tumors. Ann Surg Oncol 2024; 31:6282-6290. [PMID: 38743283 PMCID: PMC11300566 DOI: 10.1245/s10434-024-15397-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND OBJECTIVES Curettage is the removal of a tumor from the bone while preserving the surrounding healthy cortical bone, and is associated with higher rates of local recurrence. To lower these rates, curettage should be combined with local adjuvants, although their use is associated with damage to nearby healthy bone. OBJECTIVE The purpose of this analysis is to determine the effect of local adjuvants on cortical porcine bone by using micro-computed tomography (micro-CT) along with histological and mechanical examination. METHODS Local adjuvants were applied to porcine specimens under defined conditions. To assess changes in bone mineral density (BMD), a micro-CT scan was used. The pixel gray values of the volume of interest (VOI) were evaluated per specimen and converted to BMD values. The Vickers hardness test was employed to assess bone hardness (HV). The depth of necrosis was measured histologically using hematoxylin and eosin-stained tissue sections. RESULTS A noticeable change in BMD was observed on the argon beam coagulation (ABC) sample. Comparable hardness values were measured on samples following electrocautery and ABC, and lowering of bone hardness was obtained in the case of liquid nitrogen. Extensive induced depth of necrosis was registered in the specimen treated with liquid nitrogen. CONCLUSION This study determined the effect of local adjuvants on cortical bone by using micro-CT along with histological and mechanical examination. Phenolization and liquid nitrogen application caused a decrease in bone hardness. The bone density was affected in the range of single-digit percentage values. Liquid nitrogen induced extensive depth of necrosis with a wide variance of values.
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Affiliation(s)
- Vasileios Apostolopoulos
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Boháč
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, University of Technology, Brno, Czech Republic
| | - Petr Marcián
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, University of Technology, Brno, Czech Republic
| | - Iva Staniczkova Zambo
- First Department of Pathology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Lukáš Pazourek
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michal Mahdal
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Jakub Neradil
- Laboratory of Tumor Biology, Department of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Tomáš Návrat
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, University of Technology, Brno, Czech Republic
| | - Tomáš Tomáš
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.
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Bavan L, Eastley N, Stevenson J, Mifsud M, Bayliss L, Mahmoud S, Baker G, Cusick L, Nail R, Rankin K, Crooks S, Cool P, Williams D, Kandarakis G, Duncan R, Kothari A. Aneurysmal bone cysts: A UK wide tumor center experience. J Surg Oncol 2024; 129:601-608. [PMID: 37965813 DOI: 10.1002/jso.27499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/26/2023] [Accepted: 10/15/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND AND OBJECTIVES This multicenter retrospective series of consecutive extra-spinal aneurysmal bone cysts aims to identify risk factors for treatment failure. METHODS Aneurysmal bone cysts treated within seven collaborating centers with over 12-months follow-up were eligible for inclusion. Survival analyses were performed to identify variables associated with recurrence using log-rank tests and Cox proportional hazard regression. RESULTS One hundred and fifteen (M:F 60:55) patients were included. Median age at presentation was 13 years and median follow-up was 27 months. Seventy-five patients underwent surgical curettage and 27% of these required further intervention for recurrence. Of the 30 patients who underwent biopsy with limited percutaneous curettage as initial procedure, 47% required no further treatment. Patients under 13 years (log-rank p = 0.006, HR 2.3, p = 0.011) and those treated who had limited curettage (log-rank p = 0.001, HR 2.7, p = 0.002) had a higher risk of recurrence/persistence. CONCLUSIONS There is a high risk of recurrence following surgical treatment for aneurysmal bone cysts and this risk is higher in young patients. However, the cyst heals in a substantial number of patients who have a limited curettage at the time of biopsy.
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Affiliation(s)
- Luckshman Bavan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Jonathan Stevenson
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Aston Medical School, Aston University, Birmingham, UK
| | | | - Lee Bayliss
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Shady Mahmoud
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gavin Baker
- Belfast Health and Social Care Trust, Belfast, UK
| | | | - Rebecca Nail
- Newcastle Upon Tyne Hospital NHS Trust, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Kenneth Rankin
- Newcastle Upon Tyne Hospital NHS Trust, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Sophie Crooks
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Paul Cool
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Derfel Williams
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | | | | | - Alpesh Kothari
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Jahangiri P, Roohollahi F, Habibi Z, Mirbolouk MH, Rostami M. Management of aggressive recurrent thoracic spine aneurysmal bone cyst in a 7-year-old male: A case report and review of the literature. Surg Neurol Int 2024; 15:30. [PMID: 38468663 PMCID: PMC10927180 DOI: 10.25259/sni_886_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/29/2023] [Indexed: 03/13/2024] Open
Abstract
Background Spinal aneurysmal bone cysts (ABCs) are rare, histologically benign tumors with aggressive behavior, which may cause bone and soft-tissue destruction, particularly affecting neural elements. Management of these tumors, including treatment modalities and follow-up protocols, remains challenging. Case Description A 7-year-old boy presented with chest wall pain persisting for two months before admission, accompanied by progressive mono paresis lasting ten days before admission. Myelopathy signs were evident during the examination. Imaging confirmed a multicystic lesion at the T6 level involving the posterior elements of the vertebra, with significant cord compression. Due to deteriorating neurological function, he underwent urgent laminectomy and neural decompression, followed by subtotal tumor resection. Postoperative histopathological examination confirmed the diagnosis of an ABC, and the patient experienced significant neurological recovery. However, after 21 days, the patient was readmitted to the emergency department with severe paraparesis. Magnetic resonance imaging revealed rapid growth of the residual tumor, leading to cord compression. He underwent aggressive total tumor resection, T6 vertebral body corpectomy, and fixation with pedicle screws and cage insertion. Following the second surgery, prompt neurological recovery occurred. Conclusion This rare case report emphasizes the importance of a close follow-up protocol for spinal ABCs in the pediatric population. It highlights the challenges in managing these tumors and the need for vigilant monitoring to detect and address rapid recurrences.
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Affiliation(s)
- Pedram Jahangiri
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Faramarz Roohollahi
- Sport Medicine Research Center, Tehran University of Medical Sciences, Yas Hospital, Tehran, Iran
| | - Zohreh Habibi
- Department of Pediatric Neurosurgery, Tehran University of Medical Sciences, Children’s Medical Center, Tehran, Iran
| | | | - Mohsen Rostami
- Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Bakarman KA. Diagnosis and Current Treatment of Aneurysmal Bone Cysts. Cureus 2024; 16:e53587. [PMID: 38449944 PMCID: PMC10915701 DOI: 10.7759/cureus.53587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 03/08/2024] Open
Abstract
The purpose of this review is to increase awareness about the evolution and development of current trends in the diagnosis and treatment of aneurysmal bone cysts (ABCs). ABCs are benign, but locally aggressive bone tumors that mainly affect children. ABCs comprise 1% of all primary bone tumors and occur most frequently during the first two decades of life. The diagnosis is made using a variety of imaging modalities and has the characteristic features of an expansile, radiolucent lesion that is often seen in the metaphyseal region of the bone and has fluid-fluid levels that are apparent on MRI. In the pediatric population, telangiectatic osteosarcoma and unicameral bone cyst (UBC) are the main differential diagnoses of an ABC. Giant cell tumors (GCTs) also include in differential diagnosis, which often manifest in patients older than 15 and do not penetrate the open physis although they develop after the physeal closure. Imaging alone cannot rule out telangiectatic osteosarcoma; therefore, a biopsy is recommended. A variety of treatment options have been described; traditionally, most patients are treated with curettage and bone grafting. Curettage alone, however, usually results in tumor recurrence following excision. A variety of adjuvants have been utilized with varying degrees of effectiveness to reduce the risk of local recurrence. When a cyst is in the pelvis, its location and size are such that surgery is a very risky option. Selective arterial embolization has significantly contributed to the development of effective treatments for these situations. Embolization or radiation, as well as denosumab therapy, are widely used as therapies for ABCs in anatomic locations where surgery would significantly increase morbidity.
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Flyer BE, Vanstrum EB, Chapman N, Ha JH, Al-Husseini JK, Chu JK, McComb JG, Durham SR, Krieger MD, Chiarelli PA. Surgical management of pediatric spinal aneurysmal bone cysts: patient series. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 7:CASE23637. [PMID: 38252929 PMCID: PMC10805592 DOI: 10.3171/case23637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Aneurysmal bone cysts (ABCs) are rare, highly vascular osteolytic bone lesions that predominantly affect pediatric populations. This report evaluates the clinicopathological data of pediatric patients with spinal ABCs. The medical records for all patients at Children's Hospital Los Angeles with biopsy-proven ABCs of the spine between 1998 and 2018 were evaluated. OBSERVATIONS Seventeen patients, 6 males and 11 females, were identified. The mean age at surgery was 10.4 years (range, 3.5-20 years). The most common presenting complaint was pain at the lesion site 16/17 (94%), followed by lower-extremity weakness 8/17 (47%). Resection and intralesional curettage were performed in all patients. Three (18%) of 17 patients underwent selective arterial embolization prior to resection. Spinal stability was compromised in 15 of 17 patients (88%), requiring instrumented fusion. Five (29%) of the 17 patients received additional therapy including radiation, calcitonin-methylprednisolone, or phenol. Four (23.5%) of 17 patients experienced a recurrence, and the mean time to recurrence was 15 months. The postoperative follow-up ranged from 6 to 108 months (median, 28 months). Reoperation occurred after an average of 35 months. At the recent follow-up, patients were free of disease. LESSONS Gross-total resection by intralesional curettage with case-dependent instrumented spinal fusion for instability remains an effective strategy for managing pediatric spinal ABCs. Long-term follow-up is necessary to detect tumor recurrence.
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Affiliation(s)
- Benjamin E Flyer
- 1Division of Neurosurgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
- 3Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina; and
| | - Erik B Vanstrum
- 4Department of UCLA Head & Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Nicholas Chapman
- 1Division of Neurosurgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joseph H Ha
- 1Division of Neurosurgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jacob K Al-Husseini
- 1Division of Neurosurgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jason K Chu
- 1Division of Neurosurgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - J Gordon McComb
- 1Division of Neurosurgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Susan R Durham
- 1Division of Neurosurgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mark D Krieger
- 1Division of Neurosurgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
- 2Department of Surgery, Children's Hospital Los Angeles, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Peter A Chiarelli
- 1Division of Neurosurgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
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Cevolani L, Staals E, Campanacci L, Dozza B, Martella C, Spinnato P, Di Carlo M, Peta G, Donati DM, Miceli M, Facchini G. Aneurysmal bone cyst: Is selective arterial embolization effective as curettage and bone grafting? J Surg Oncol 2023; 128:1428-1436. [PMID: 37638388 DOI: 10.1002/jso.27422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/31/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Aneurysmal bone cyst (ABC) is a lytic benign bone lesion representing about 1% of all primary bone tumors. Method to treat ABC's have developed over time. The standard of care cure for ABC has been curettage with or without bone grafting of the defect but is burdened by recurrence rates of approximately 25%-31%. Based on the assumption that ABCs usually supplied by one or more pathological feeding arteries, selective arterial embolization has been described as an adjuvant preoperative procedure to reduce intra-operative hemorrhage, and as primary treatment for lesions in difficult surgical access. In the current study, we therefore asked whether (1) a single or a repeat selective arterial embolization (SAE) for treating ABCs would produce comparable healing rates compared with curettage and bone grafting; (2) evaluated the relationship of recurrence in relation to the site of the cyst, the age, and gender of the patients; and (3) the two techniques differ in term of long-term complication. MATERIAL AND METHODS We retrospectively reviewed 265 patients who underwent curettage and bone grafting or SAE performed at our institute from 1994 to 2018. The diagnosis of ABC was always established with percutaneous CT-guided biopsy or open biopsy. Patients were followed clinically with plain radiographs or CT scan at 3, 6, 9, and 12 months then annually in the absence of symptoms. Treatment success was determined evaluating pre- and postprocedural imaging according to Chang classification. RESULTS Two hundred and nineteen were treated with curettage and bone grafting (curettage group), and 46 with SAE Group. Of the 219 patients treated with Curettage and bone grafting (curettage group), 165 out of 219 (75.3%) experienced bone healing, while local recurrence was observed in 54 cases (24.7%) after 12 months on average (range: 3-120 months) from surgery. After the first SAE, bone ossification was seen in 27 (58.7%), without needing any further treatment. Eleven recurred patients were treated with SAE (four patients need two while seven need three SAE to heal), and eight patients with curettage and bone grafting. Thirty-eight out of 46 (82%) patients experienced bone ossification regardless the number of SAE. The overall rate of local recurrence for all patients was 26.7%. SAE group presented a lower complication rate (6%) where two patients experienced skin necrosis, and one limb-length discrepancies (2% of all cohort). DISCUSSION The use of SAE is an attractive option to treat ABC as it combines on one hand a lower complication rate than curettage and bone grafting, on the other it can be carried out in case of nonresectable ABCs, significantly reducing the size of viable ABC lesions, fostering bone remodeling and mineralization, and most importantly, significantly improving the patient's quality of life.
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Affiliation(s)
- Luca Cevolani
- Unit of 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eric Staals
- Unit of 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Laura Campanacci
- Unit of 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Barbara Dozza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Claudia Martella
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maddalena Di Carlo
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuliano Peta
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide M Donati
- Unit of 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Andreani L, Ipponi E, Serrano E, De Franco S, Cordoni M, Bechini E, D’Arienzo A, Parchi PD. Aneurysmal Bone Cyst of the Pelvis in Children and Adolescents: Effectiveness of Surgical Treatment with Curettage, Cryotherapy and Bone Grafting. Healthcare (Basel) 2023; 11:2658. [PMID: 37830695 PMCID: PMC10572795 DOI: 10.3390/healthcare11192658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Aneurysmal bone cysts (ABCs) are benign but locally aggressive cystic lesions of the bone. Pelvic ABCs are extremely rare and hard to treat due to their high risk of local recurrence and the tough access to pelvic bones. METHODS In this retrospective study, we evaluated pediatric cases with pelvic ABC treated with curettage, cryotherapy and bone grafting treated in our institution between 2016 and 2022. Complications were recorded, as well as local recurrences. Patients' post-operative functionality was assessed with the MSTS score. RESULTS Fourteen consecutive cases were included in our study. Their mean age at surgery was 13.5 years. The mean lesion size was 55 mm. The mean follow-up was 38 months. Two cases (11.8%) had local recurrences, which were successfully treated with further curettage. At their latest FU, 13 cases were continuously disease free (CDF), and one had no evidence of disease (NED). Only one case had a post-operative compilation (wound dehiscence). Patients' mean post-operative MSTS score was 29.6. CONCLUSIONS Pelvic ABCs are a challenge, even for the most experienced orthopedic surgeon. Our study suggests that the association of an accurate curettage, intraoperative cryotherapy and bone grafting can be a reliable and effective therapeutic option for large-sized ABCs of the pelvis.
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Affiliation(s)
| | - Edoardo Ipponi
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy; (L.A.); (E.S.); (S.D.F.); (M.C.); (E.B.); (A.D.); (P.D.P.)
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Gajewski CR, Alhushki W, Benhaim P, Bernthal NM, Wessel L. Approach to the Treatment of Expansile Metacarpal Aneurysmal Bone Cysts: A Report of Two Cases. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:689-694. [PMID: 37790824 PMCID: PMC10543794 DOI: 10.1016/j.jhsg.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/06/2023] [Indexed: 10/05/2023] Open
Abstract
The two cases presented demonstrate the management of aneurysmal bone cysts of the metacarpal, which destroyed the normal bone architecture. Treatment of both cases included wide resection and metacarpal reconstruction with an intercalary fibular allograft. Denosumab use contrasts these two cases and is helpful in reestablishment of a cortical rim for fixation in the absence of a 1-cm margin proximally or distally to preserve the native carpometacarpal and metacarpophalangeal joints. Surgical resection and allograft reconstruction is a viable treatment for expansile metacarpal aneurysmal bone cysts, and neoadjuvant denosumab has utility in creating an ossified margin for fixation.
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Affiliation(s)
| | | | | | | | - Lauren Wessel
- UCLA Department of Orthopaedic Surgery, Los Angeles, CA
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Smolle MA, Roessl V, Leithner A. Effect of Local Adjuvants Following Curettage of Benign and Intermediate Tumours of Bone: A Systematic Review of the Literature. Cancers (Basel) 2023; 15:4258. [PMID: 37686534 PMCID: PMC10487159 DOI: 10.3390/cancers15174258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Local adjuvants are used upon intralesional resection of benign/intermediate bone tumours, aiming at reducing the local recurrence (LR) rate. However, it is under debate whether, when and which local adjuvants should be used. This PRISMA-guideline based systematic review aimed to analyse studies reporting on the role of adjuvants in benign/intermediate bone tumours. All original articles published between January 1995 and April 2020 were potentially eligible. Of 344 studies identified, 58 met the final inclusion criteria and were further analysed. Articles were screened for adjuvant and tumour type, follow-up period, surgical treatment, and development of LR. Differences in LR rates were analysed using chi-squared tests. Altogether, 3316 cases (10 different tumour entities) were analysed. Overall, 32 different therapeutic approaches were identified. The most common were curettage combined with high-speed burr (n = 774; 23.3%) and high-speed burr only (n = 620; 18.7%). The LR rate for studies with a minimum follow-up of 24 months (n = 30; 51.7%) was 12.5% (185/1483), with the highest rate found in GCT (16.7%; 144/861). In comparison to a combination of curettage, any adjuvant and PMMA, the sole application of curettage and high-speed burr (p = 0.015) reduced the LR rate in GCT. The overall complication rate was 9.6% (263/2732), which was most commonly attributable to postoperative fracture (n = 68) and osteoarthritis of an adjacent joint during follow-up (n = 62). A variety of adjuvants treatment options are reported in the literature. However, the most important step remains to be thorough curettage, ideally combined with high-speed burring.
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Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; (V.R.); (A.L.)
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10
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Chalamgari A, Valle D, Palau Villarreal X, Foreman M, Liu A, Patel A, Dave A, Lucke-Wold B. Vertebral Primary Bone Lesions: Review of Management Options. Curr Oncol 2023; 30:3064-3078. [PMID: 36975445 PMCID: PMC10047554 DOI: 10.3390/curroncol30030232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/26/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
The assessment and treatment of vertebral primary bone lesions continue to pose a unique yet significant challenge. Indeed, there exists little in the literature in the way of compiling and overviewing the various types of vertebral lesions, which can often have complicated intervention strategies. Given the severe consequences of mismanaged vertebral bone tumors-including the extreme loss of motor function-it is clear that such an overview of spinal lesion care is needed. Thus, in the following paper, we aim to address the assessment of various vertebral primary bone lesions, outlining the relevant nonsurgical and surgical interventional methods. We describe examples of primary benign and malignant tumors, comparing and contrasting their differences. We also highlight emerging treatments and approaches for these tumors, like cryoablation and stereotactic body radiation therapy. Ultimately, we aim to emphasize the need for further guidelines in regard to correlating lesion type with proper therapy, underscoring the innate diversity of vertebral primary bone lesions in the literature.
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Affiliation(s)
| | | | | | | | | | | | | | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL 32601, USA
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Döring K, Puchner S, Vertesich K, Funovics PT, Hobusch G, Sulzbacher I, Chiari C, Windhager R. Results in the surgical treatment of aneurysmal bone cysts - A retrospective data analysis. Orthop Traumatol Surg Res 2022; 108:103095. [PMID: 34601159 DOI: 10.1016/j.otsr.2021.103095] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 11/20/2020] [Accepted: 01/26/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Aneurysmal bone cysts (ABC) are benign tumors mostly occurring in children and young adults. Different open and minimal invasive surgical approaches have been proposed for the treatment of ABCs and yet no consensus is defined to date. The aim of this study was to retrospectively review data of a large single center series of ABCs with patients treated by open curettage with or without filling of the cavity or en-bloc resection. Questions/purposes We asked: (1) What was the local recurrence rate of ABC after surgical treatment at our institution? (2) What were positive or negative predictors for local recurrence? (3) Was there a benefit from adjuvant burring, phenolization or filling, respectively? (4) Where there changes in recurrence free survival in different time periods of primary surgery? METHODS By retrospective data analysis of the Vienna Bone and Soft Tissue Tumor Registry, 123 patients surgically treated for primary aneurysmal bone cysts were identified. After exclusion of 33 patients (27%) due to a postoperative follow up below one year, 90 patients who were treated for primary ABCs between 1986 and 2009 were evaluated. These included 50 males and 40 females with a mean age of 16 years (SD 10 years; range: 2 to 51 years). The mean follow-up was 99 months. (SD 72 months, range: 13 to 329 months) RESULTS: Curettage was performed in 84 patients, while 45 patients received adjuvant phenolization. Local recurrence occurred in 28 patients after a mean time of 16 months, with a corresponding local recurrence free survival (RFS) of 83% after one year, 77% after 2 years and 66% after 5 years. ABCs located in hands and feet (p=0.044) showed a superior RFS, while younger patients (p=0.001) displayed an inferior RFS. Regarding adjuvant surgical techniques, mechanical cavity burring (p=0.004) and filling with autologous cancellous bone graft (p=0.024) showed protective effects on RFS. Patients treated between 1986 and 1999 (n=47) had a higher RFS than patients treated between 2000 and 2009 (n=43, p=0.011), as surgeons and surgical indications changed over time. CONCLUSION Although curettage, burring, phenolization and reconstruction with bone grafts came with a relatively high risk of local recurrence, open surgery is still justified in aggressively growing ABCs of critical localizations. LEVEL OF EVIDENCE IV; therapeutic study.
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Affiliation(s)
- Kevin Döring
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
| | - Stephan Puchner
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Klemens Vertesich
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Philipp T Funovics
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Hobusch
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Irene Sulzbacher
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Catharina Chiari
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
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Kumar D, Kumar S, Kumar D, Patel BM, Kumar A, Kumar S, Waliullah S. Sclerotherapy for Aneurysmal Bone Cyst: A Single-Center Experience. Cureus 2021; 13:e18469. [PMID: 34754635 PMCID: PMC8564749 DOI: 10.7759/cureus.18469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Sclerotherapy offers an alternative to surgery to treat an aneurysmal bone cyst (ABC). The present study's main objective was to assess the radiological efficacy of sclerotherapy in the healing of the cyst cavity secondary to biopsy-proven ABC on X-rays and assess clinical efficacy on pain, recurrence, and complications. Materials and methods Between 2016 and 2018, 26 patients (12 females, 14 males) with biopsy-proven ABC treated by sclerotherapy were included. All patients received an injection of polidocanol 3% intralesional as standard treatment under fluoroscopic guidance. Ossification was assessed on plain X-ray, and the pain was evaluated on a visual analog scale (VAS). Results Ossification was complete in 24 (92.3%) patients and partial in two (7.7%) patients. Eighteen patients (70%) were pain-free at the end of three months. There was an improvement in the VAS score, and clinically, there was a significant reduction in pain and swelling. Two patients developed recurrence within two years of follow-up, treated successfully by the re-application of intralesional polidocanol 3% injection. Discussion Sclerotherapy provides an effective, minimally invasive treatment for ABC and is particularly useful for deep lesions, challenging access for surgery and potentially damaging vital structures. The use of percutaneous polidocanol 3% under fluoroscopic control seems to improve the risk/benefit ratio. Its clinical and radiological efficacy makes sclerotherapy an alternative treatment option in ABC. Level of evidence IV, prospective study
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Affiliation(s)
- Deepak Kumar
- Orthopedic Surgery, King Georges Medical University, Lucknow, IND
| | - Sanjeev Kumar
- Orthopedic Surgery, King Georges Medical University, Lucknow, IND
| | - Dharmendra Kumar
- Orthopedic Surgery, King Georges Medical University, Lucknow, IND
| | - Brij Mohan Patel
- Department of Orthopedics, Mahamaya Government Medical College, Ambedkar Nagar, IND
| | - Ashish Kumar
- Orthopedic Surgery, King Georges Medical University, Lucknow, IND
| | - Santosh Kumar
- Orthopedic Surgery, King Georges Medical University, Lucknow, IND
| | - Shah Waliullah
- Orthopedic Surgery, King Georges Medical University, Lucknow, IND
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Combined Transarterial Embolization and Percutaneous Sclerotherapy as Treatment for Refractory and Nonresectable Aneurysmal Bone Cysts. J Vasc Interv Radiol 2021; 32:1425-1434.e2. [PMID: 34293437 DOI: 10.1016/j.jvir.2021.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/04/2021] [Accepted: 07/12/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of combined transarterial embolization and percutaneous sclerotherapy in the treatment of refractory and nonresectable aneurysmal bone cysts (ABCs) as assessed by imaging and clinical outcomes. MATERIALS AND METHODS This retrospective, single-center study included 16 consecutive patients (9 women and 7 men; median age, 17 years [range, 6-25 years]) who underwent combined transarterial embolization (using ethylene vinyl alcohol) and percutaneous sclerotherapy (using ethanol gel and polidocanol) for refractory and nonresectable ABCs. The median follow-up was 27.3 months (range, 6.7-47.5 months). Grade of mineralization (5-point Likert scale), grade of fluid-fluid levels (FFLs; 4-point Likert scale), and contrast-enhancing lesion volume were evaluated before and after treatment. The quality of life was determined before and after treatment using the Musculoskeletal Tumor Society (MSTS) score and the 36-Item Short Form Survey (SF-36) health questionnaire. RESULTS A mean of 1.6 ± 0.7 transarterial embolizations and 3.2 ± 1.7 percutaneous sclerotherapies were performed. No adverse events were observed. All patients showed either partial or complete response; no patient showed ABC recurrence. The grade of mineralization (3.7 ± 0.7 after therapy vs 1.4 ± 0.5 at baseline; P < .0001) and grade of FFL (3.5 ± 0.8 after therapy vs 1.9 ± 0.6 at baseline; P < .0001) significantly improved after therapy compared with baseline. The mean contrast-enhancing lesion volume significantly decreased after treatment compared with baseline (45.9 mm³ ± 96.1 vs 156.0 mm³ ± 115.3, respectively; P = .0003). The MSTS scores (28.8 ± 1.8 after treatment vs 14.1 ± 8.6 at baseline; P < .0001) and SF-36 findings revealed a significant improvement in the quality of life after treatment compared with baseline, leaving most patients without relevant constraints. CONCLUSIONS Combined transarterial embolization and percutaneous sclerotherapy is a minimally invasive, safe, and effective treatment option for refractory and nonresectable ABCs. Treatment fostered bone mineralization and significantly improved patients' quality of life.
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Cevolani L, Campanacci L, Sambri A, Lucarelli E, De Paolis M, Donati DM. Is percutaneous injection of bone marrow concentrate, demineralized bone matrix and PRF an alternative to curettage and bone grafting for treating aneurysmal bone cyst? J Tissue Eng Regen Med 2021; 15:269-278. [PMID: 33462983 DOI: 10.1002/term.3175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/12/2020] [Accepted: 01/06/2021] [Indexed: 11/11/2022]
Abstract
To determine the efficacy and safety of a single injection with autologous bone marrow concentrate (BMC) combined with demineralized bone matrix (DBM) and platelet-rich fibrin (PRF) compared to curettage and bone grafting for treating aneurysmal bone cysts (ABC). Two hundred thirty-nine patients were treated with curettage and bone grafting (Curettage Group), and 21 with percutaneous injection of DBM associated with autologous BMC and PRF (DBM + BMC + PRF Group). All patients attended the outpatient clinic to assess ABC healing and clinical results at the first 3, 6, 9 and 18 months after surgery and then annually in the absence of symptoms. The mean follow-up was 42 months for the Curettage Group (range 6-180 months) and 28 months for the DBM + BMC + PRF Group (range, 6-85 months). Out of the 21 patients who had injection with BMC, DBM, and PRF, 17 (80%) require no additional treatment and they were considered healed. Of the 239 patients treated with curettage and bone grafting after core needle or open biopsy, 177 (74%) were considered healed after the first treatment. Injection in comparison with curettage presented the same risk for local recurrence. The overall rate of local recurrence for all patients was 25%. Univariate and multivariate analyses showed a significant difference in local recurrence rates in patients younger than 15 years, and for the cyst located in the long bones of the lower limbs than the cyst located in the long bones of the upper limbs.
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Affiliation(s)
- Luca Cevolani
- Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Laura Campanacci
- Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Sambri
- Orthopaedic and Traumatologic Clinic, IRCCS Azienda Ospedaliera S. Orsola-Malpighi, Bologna, Italy
| | - Enrico Lucarelli
- Unit of Orthopaedic Pathology and Osteoarticular Tissue Regeneration, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano De Paolis
- Orthopaedic and Traumatologic Clinic, IRCCS Azienda Ospedaliera S. Orsola-Malpighi, Bologna, Italy
| | - Davide Maria Donati
- Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Unit of Orthopaedic Pathology and Osteoarticular Tissue Regeneration, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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15
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Abstract
AIMS Aneurysmal bone cysts (ABCs) are locally aggressive lesions typically found in the long bones of children and adolescents. A variety of management strategies have been reported to be effective in the treatment of these lesions. The purpose of this review was to assess the effectiveness of current strategies for the management of primary ABCs of the long bones. METHODS A systematic review of the published literature was performed to identify all articles relating to the management of primary ABCs. Studies required a minimum 12-month follow-up and case series reporting on under ten participants were not included. RESULTS A total of 28 articles meeting the eligibility criteria were included in this review, and all but one were retrospective in design. Due to heterogeneity in study design, treatment, and outcome reporting, data synthesis and group comparison was not possible. The most common treatment option reported on was surgical curettage with or without a form of adjuvant therapy, followed by injection-based therapies. Of the 594 patients treated with curettage across 17 studies, 86 (14.4%) failed to heal or experienced a recurrence. Similar outcomes were reported for 57 (14.70%) of the 387 patients treated with injection therapy across 12 studies. Only one study directly compared curettage with injection therapy (polidocanol), randomizing 94 patients into both treatment groups. This study was at risk of bias and provided low-quality evidence of a lack of difference between the two interventions, reporting success rates of 93.3% and 84.8% for injection and surgical treatment groups, respectively. CONCLUSION While both surgery and sclerotherapy are widely implemented for treatment of ABCs, there is currently no good quality evidence to support the use of one option over the other. There is a need for prospective multicentre randomized controlled trials (RCTs) on interventions for the treatment of ABCs. Cite this article: Bone Jt Open 2021;2(2):125-133.
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Affiliation(s)
- Luckshman Bavan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Asanka Wijendra
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alpesh Kothari
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Calanna F, Chen F, Risitano S, Vorhies JS, Franceschini M, Giori NJ, Indelli PF. Debridement, antibiotic pearls, and retention of the implant (DAPRI): A modified technique for implant retention in total knee arthroplasty PJI treatment. J Orthop Surg (Hong Kong) 2020; 27:2309499019874413. [PMID: 31554470 DOI: 10.1177/2309499019874413] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
We describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure to improve the possibilities of retaining an infected total knee arthroplasty. This technique, debridement antibiotic pearls and retention of the implant (DAPRI), aims to remove the intra-articular biofilm allowing a higher and prolonged local antibiotic concentration using calcium sulfate beads. The combination of three different surgical techniques (methylene blue staining, argon beam electrical stimulation, and chlorhexidine gluconate brushing) might enhance the identification, disruption, and finally removal of the bacterial biofilm, which is the main responsible of antibiotics and antibodies resistance. The DAPRI technique might represent a safe and more conservative treatment for acute and early hematogenous periprosthetic joint infection.
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Affiliation(s)
- Filippo Calanna
- Istituto Ortopedico Gaetano Pini, Division of Orthopaedic Surgery, Milan, Italy
| | - Foster Chen
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Salvatore Risitano
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - John S Vorhies
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | | | - Nicholas J Giori
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
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Bickels J, Campanacci DA. Local Adjuvant Substances Following Curettage of Bone Tumors. J Bone Joint Surg Am 2020; 102:164-174. [PMID: 31613863 DOI: 10.2106/jbjs.19.00470] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jacob Bickels
- Unit of Orthopedic Oncology, Orthopedic Division, Hillel-Yaffe Medical Center, Hadera, Rappaport Faculty of Medicine, The Technion, Israel
| | - Domenico A Campanacci
- Unit of Orthopaedic Oncology, Department of Health Sciences, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
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Challenges in the Diagnosis and Treatment of Aneurysmal Bone Cyst in Patients with Unusual Features. Adv Orthop 2019; 2019:2905671. [PMID: 31467722 PMCID: PMC6701321 DOI: 10.1155/2019/2905671] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/16/2019] [Accepted: 07/11/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives Aneurysmal bone cyst (ABC) is a benign but locally aggressive tumor. It has several challenging features. The aim of this study is to identify challenges in the diagnosis and treatment of ABC especially in patients with unusual features. Methods This retrospective study involved medical record review of primary ABC patients with one or more of the following features: unusual clinical presentation with a mass or a pathological fracture especially at an unusual age, rare locations, radiological findings suggesting other diagnoses especially sarcoma, and a nondiagnostic histopathology of biopsy samples. Results 25 patients (17 males and 8 females) were included. Most patients were either younger than 10 or older than 20 years. 10 patients presented with a mass or a pathological fracture. Unusual locations include the scapula, the olecranon, the hamate, the calcaneus, and the first metatarsal bone. Extension into the epiphysis occurred in 2 patients with proximal fibula and olecranon ABCs. Two separate synchronous cysts existed in the proximal epiphysis and middiaphysis of one humerus. Radiological imaging suggested other primary diagnoses in 8 patients. Core needle biopsy was diagnostic in only 2 of 7 patients. The main treatment was intralesional resection/curettage with bone grafting. Wide resection was performed in 4 patients. Recurrence rate was 28%. Recurrence risk factors included the following: age less than 10 years, male gender, and proximal femur location. Late recurrence occurred in 3/7 patients. One patient with asymptomatic radiological recurrence showed subsequent spontaneous resolution one year later. Conclusions This study presented multiple unusual features of ABC including: unusual age, rare locations, and nondiagnostic radiological and histopathological findings. These features can complicate the diagnosis and management. Given these features, especially with pathological fractures, a well-planned incision, the use of frozen section examination, and the application of either external fixation or plate osteosynthesis for fracture fixation can be recommended.
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Aiba H, Kobayashi M, Waguri-Nagaya Y, Goto H, Mizutani J, Yamada S, Okamoto H, Nozaki M, Mitsui H, Miwa S, Kobayashi M, Endo K, Saito S, Goto T, Otsuka T. Treatment of aneurysmal bone cysts using endoscopic curettage. BMC Musculoskelet Disord 2018; 19:268. [PMID: 30053808 PMCID: PMC6064064 DOI: 10.1186/s12891-018-2176-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 07/10/2018] [Indexed: 01/30/2023] Open
Abstract
Background Although aneurysmal bone cysts (ABCs) are benign tumours, they have the potential to be locally aggressive. Various treatment approaches, such as en bloc resection, open curettage, radiotherapy, sclerotherapy, and embolization have been proposed, but the most appropriate treatment should be selected after considering the risk of tumour recurrence and treatment complications. Endoscopic curettage (ESC) may be a less invasive alternative to open curettage for ABC treatment. We aimed to describe the use of ESC for the treatment of ABCs and to report our clinical outcomes, including the incidence rate of recurrence, radiological appearance at final follow-up, time to solid union, complications, and postoperative function. Methods Between 1998 and 2015, 30 patients (18 men and 12 women; mean age, 17.4 years) underwent ESC for the treatment of primary ABCs at our hospital (mean postoperative follow-up, 55 months). ESC was performed under arthroscopic guidance for direct visualization, and curettage extended until normal bone was observed in the medullary cavity. To investigate bone healing after ESC, we evaluated the consolidation of cysts at the final evaluation (based on the modified Neer classification) and time to solid union after surgery, which was defined as sufficient cortical bone thickness to prevent fracture and allow physical activities. Results Recurrence was identified in 3 cases (10%). Curative outcomes were obtained after repeated ESC or open curettage. A log-rank analysis indicated that age < 10 years (p = 0.004) and contact of the tumour with the physis (p = 0.01) increased the risk of tumour recurrence. Residual tumours were identified in 9 cases (30%); these lesions remained inactive over the extended follow-up period. The average time to solid union after endoscopic curettage was 3.2 months. Transient radial nerve palsy was identified in 1 case. Good postoperative functional recovery occurred in all cases. Conclusions ESC is a minimally invasive technique for the treatment of ABCs, and the tumour recurrence rate is comparable to that of other standard procedures. However, the application of this method should be carefully considered, especially for patients < 10 years and when the tumour comes in contact with the physis. Electronic supplementary material The online version of this article (10.1186/s12891-018-2176-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hisaki Aiba
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Masaaki Kobayashi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan. .,Department of Orthopedic Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, 503-8502, Japan.
| | - Yuko Waguri-Nagaya
- Department of Joint Surgery for Rheumatic Diseases, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Hideyuki Goto
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Jun Mizutani
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Satoshi Yamada
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Hideki Okamoto
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Masahiro Nozaki
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Hiroto Mitsui
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Shinji Miwa
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Makoto Kobayashi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Kojiro Endo
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Shiro Saito
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Taeko Goto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Takanobu Otsuka
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
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Daley E, Kurdziel MD, Koueiter D, Moore DD. Characterization of doxycycline-loaded calcium phosphate cement: implications for treatment of aneurysmal bone cysts. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:109. [PMID: 29987657 DOI: 10.1007/s10856-018-6117-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 06/26/2018] [Indexed: 06/08/2023]
Abstract
Percutaneous doxycycline for treatment for aneurysmal bone cysts (ABCs) has been shown to decrease recurrence rates, however, this requires multiple procedures, includes the risks soft tissue necrosis, and does not provide structural support. We propose utilizing curettage with doxycycline-loaded calcium phosphate cement. This study aimed to evaluate the elution profile of doxycycline from calcium phosphate cement. Calcium phosphate cement underwent an in vitro elution protocol evaluating doxycycline concentrations of 0, 5, 10, and 15 mg/mL. Eluted concentrations were quantified utilizing high performance liquid chromatography at predetermined time points over 96 h. Compressive strength was evaluated both pre- and post-elution and micro-computed tomography was utilized to assess changes in cement porosity. Cement with 15 mg/mL of doxycycline maintained a higher average concentration (mean, 95% confidence intervals) (14.5 µg/mL [9.2-19.9 µg/mL]) compared to both 5 mg/mL (5.8 µg/mL [3.1-8.6 µg/mL]; P < 0.001) and 10 mg/mL (8.4 ± µg/mL [6.0-10.9 µg/mL]; P < 0.001). Ultimate stress significantly decreased between pre- and post-elution samples for 10 mg/mL (P= 0.001) and 15 mg/mL (P = 0.004) groups. This study demonstrated a dose-dependent response in ultimate strength and compressive modulus with addition of doxycycline to calcium phosphate cement.
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Affiliation(s)
- Erika Daley
- Department of Orthopaedic Surgery, Beaumont Health, 3601 W. 13 Mile Rd, Royal Oak, MI, 48073, USA
| | - Michael D Kurdziel
- Department of Orthopaedic Surgery, Beaumont Health, 3601 W. 13 Mile Rd, Royal Oak, MI, 48073, USA
- Department of Orthopaedic Surgery, Oakland University-William Beaumont School of Medicine, 2200 N Squirrel Rd, Rochester, MI, 48309, USA
| | - Denise Koueiter
- Department of Orthopaedic Surgery, Beaumont Health, 3601 W. 13 Mile Rd, Royal Oak, MI, 48073, USA
| | - Drew D Moore
- Department of Orthopaedic Surgery, Beaumont Health, 3601 W. 13 Mile Rd, Royal Oak, MI, 48073, USA.
- Department of Orthopaedic Surgery, Oakland University-William Beaumont School of Medicine, 2200 N Squirrel Rd, Rochester, MI, 48309, USA.
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Mostafa MF, Abed YY, Fawzy SI. Shaped graft for aneurysmal bone cyst of upper limb bones. Strategies Trauma Limb Reconstr 2017; 12:151-158. [PMID: 28712047 PMCID: PMC5653600 DOI: 10.1007/s11751-017-0291-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 06/27/2017] [Indexed: 11/26/2022] Open
Abstract
The optimal treatment of aneurysmal bone cyst remains challenging. The aim of this prospective study was to evaluate the results of using bone grafts shaped to the defects caused by aneurysmal bone cysts of upper limb bones. Fifteen patients (12 males and 3 females) with an average age of 12 years (range 6-16 years) were treated for aneurysmal bone cysts of upper limb bones by intralesional resection, argon beam coagulation and shaped bone graft. The grafts were harvested from 14 patients (11 fibulas and 3 iliac bones) and from the mother of one patient (proximal fibula). Osteosynthesis was required to stabilize the graft in four cases. The modified Enneking's scoring system was used for functional evaluation. One patient developed partial recurrence at 6 months and required reoperation. Superficial wound infection was encountered in one patient. Shortening of the humeral segment was seen in two patients (1 and 1.5 cm) but without angular deformity. After a mean follow-up of 45 months (range 24-68 months), the mean functional score was 97.3%. This technique proved to be reliable in obtaining a well reconstructed and growing bone with no or minimal deformity and good function.
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Affiliation(s)
- Mohamed F Mostafa
- Orthopedic Oncology Unit, Department of Orthopedic Surgery, Mansoura University Hospital, 36 Al-Gomhoria Street, P.O. Box 35516, Mansoura, Egypt.
| | - Yasser Y Abed
- Orthopedic Oncology Unit, Department of Orthopedic Surgery, Mansoura University Hospital, 36 Al-Gomhoria Street, P.O. Box 35516, Mansoura, Egypt
| | - Sallam I Fawzy
- Orthopedic Oncology Unit, Department of Orthopedic Surgery, Mansoura University Hospital, 36 Al-Gomhoria Street, P.O. Box 35516, Mansoura, Egypt
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O etanol pode ser usado como adjuvante na curetagem ampla a fim de reduzir a taxa de reincidência de cisto ósseo aneurismático? Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2017.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Sasaki H, Nagano S, Shimada H, Yokouchi M, Setoguchi T, Ishidou Y, Kunigou O, Maehara K, Komiya S. Diagnosing and discriminating between primary and secondary aneurysmal bone cysts. Oncol Lett 2017; 13:2290-2296. [PMID: 28454393 PMCID: PMC5403183 DOI: 10.3892/ol.2017.5682] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 12/01/2016] [Indexed: 12/19/2022] Open
Abstract
Aneurysmal bone cysts (ABCs) are benign bony lesions frequently accompanied by multiple cystic lesions and aggressive bone destruction. They are relatively rare lesions, representing only 1% of bone tumors. The pathogenesis of ABCs has yet to be elucidated. In the present study, a series of 22 cases of primary and secondary ABC from patients treated in Department of Orthopedic Surgery, Kagoshima University Hospital (Kagoshima, Japan) from 2001–2015 were retrospectively analyzed. The average age at the time of diagnosis of primary ABC was 17.9 years. Intralesional curettage and artificial bone grafting were performed in the majority of the patients with primary ABC. The local recurrence rate following curettage for primary ABC was 18%, and the cause of local recurrence was considered to be insufficient curettage. Although no adjuvant therapy was administered during the surgeries, it may assist the prevention of local recurrence in certain cases. The cases of secondary ABC were preceded by benign bone tumors, including fibrous dysplasia, giant cell tumors, chondroblastoma and non-ossifying fibroma. The features of the secondary ABC typically reflected those of the preceding bone tumor. In the majority of cases, distinguishing the primary ABC from the secondary ABC was possible based on characteristic features, including age of the patient at diagnosis and the tumor location. In cases that exhibit ambiguous features, including a soft tissue mass or a thick septal enhancement on the preoperative magnetic resonance images, a biopsy must be obtained in order to exclude other types of aggressive bone tumors, including giant cell tumor, osteosarcoma and telangiectatic osteosarcoma.
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Affiliation(s)
- Hiromi Sasaki
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Satoshi Nagano
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Hirofumi Shimada
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Masahiro Yokouchi
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Takao Setoguchi
- The Near-Future Locomotor Organ Medicine Creation Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Yasuhiro Ishidou
- Department of Medical Joint Materials, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Osamu Kunigou
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Kosuke Maehara
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Setsuro Komiya
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
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Abstract
Aneurysmal bone cysts (ABCs) are benign bone lesions arising predominantly in the pediatric population that can cause local pain, swelling, and pathologic fracture. Primary lesions, which constitute roughly two thirds of all ABCs, are thought to be neoplastic in nature, with one third of ABCs arising secondary to other tumors. Diagnosis is made with various imaging modalities, which exhibit characteristic features such as "fluid-fluid levels," although biopsy is critical, as telangiectatic osteosarcoma cannot be excluded based on imaging alone. Currently, the standard of care and most widely employed treatment is intralesional curettage. However, tumor recurrence with curettage alone is common and has driven some to propose a multitude of adjuvants with varying efficacy and risk profiles. Historically, therapies such as en bloc resection or radiation therapy were utilized as an alternative to decrease the recurrence rate, but these therapies imposed high morbidity. As a result, modern techniques now seek to simultaneously reduce morbidity and recurrence, the pursuit of which has produced preliminary study into minimally invasive percutaneous treatments and medical management.
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Solooki S, Keikha Y, Vosoughi AR. Can ethanol be used as an adjuvant to extended curettage in order to reduce the recurrence rate of aneurysmal bone cyst? Rev Bras Ortop 2016; 52:349-353. [PMID: 28702396 PMCID: PMC5497003 DOI: 10.1016/j.rboe.2016.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 04/28/2016] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The best treatment of aneurysmal bone cyst (ABC) is still unclear. This study aimed to evaluate the usefulness of extended curettage and ethanol as an adjuvant to reduce local recurrence of ABCs. METHODS Retrospectively, 68 cases treated for primary and secondary ABCs caused by benign tumors from 2003 to 2013 were enrolled to a follow-up visit between one to ten years after the surgery. The treatment protocol was en-bloc resection, biopsy and curettage, extended curettage consisted of curettage, high-speed burring, ethanol 96%, and electrocauterization (combined four-step alcohol-using approach) followed by defect filling, consecutively. RESULTS Among 36 patients with primary ABCs (16 male, 20 female, mean age of 16 years, range 3-46 years), 29 cases were treated with the combined four-step alcohol-using approach, four patients with resection, and three with biopsy and curettage. Thirty-two cases had secondary ABCs on benign lesions (17 male, 15 female). The recurrence rate was 5.88 in all primary and secondary ABC cases; two recurrences among 29 patients with primary ABCs (6.9%) and one recurrence among the 22 cases with secondary ABCs (4.5%). CONCLUSIONS It could be suggested that the combined four-step alcohol-using approach may result in a very low recurrence rate of primary and secondary ABC lesions.
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Affiliation(s)
- Saeed Solooki
- Shiraz University of Medical Sciences, Bone and Joint Diseases Research Center, Shiraz, Iran
| | - Yaghoob Keikha
- Shiraz University of Medical Sciences, Bone and Joint Diseases Research Center, Shiraz, Iran
| | - Amir Reza Vosoughi
- Shiraz University of Medical Sciences, Bone and Joint Diseases Research Center, Shiraz, Iran
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Ansari MT, Gautam D, Kotwal PP. Mother's fibula in son's forearm: use of maternal bone grafting for aneurysmal bone cyst not amenable to curettage - a case report with review of literature. SICOT J 2016; 2:18. [PMID: 27163107 PMCID: PMC4849233 DOI: 10.1051/sicotj/2015043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
It has always been a challenge to reconstruct large bone gaps. The aim of this case report is to highlight the success of homologous maternal bone grafting in a large cystic lesion. A six and half years old boy presented to us with an aneurysmal bone cyst (ABC) of the right radius, not amenable to curettage. We excised the lesion in toto, which created an 11 cm bone loss. Considering the age of the patient, we reconstructed the bone gap with maternal fibular graft. Accordingly, 12 cm of fibular graft was harvested and fashioned to fit into the bone gap. It was fixed with an intramedullary K-wire. No cancellous graft was used in the procedure. The limb was kept in the above elbow cast till incorporation of the fibula was noted on the radiographs. Six months following surgery the skiagram showed that the fibula was incorporated. Mobilization of the elbow and wrist was started along with strengthening of the forearm muscles. K-wire was removed at nine months. At the latest follow up of 24 months, the fibula is fully incorporated, the child regained full range of motion and strength of elbow. We discuss the techniques adopted in this particular case along with the review of literature.
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Affiliation(s)
- Mohammed Tahir Ansari
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS) 110029 New Delhi India
| | - Deepak Gautam
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS) 110029 New Delhi India
| | - Prakash P Kotwal
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS) 110029 New Delhi India
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Tsagozis P, Brosjö O. Current Strategies for the Treatment of Aneurysmal Bone Cysts. Orthop Rev (Pavia) 2015; 7:6182. [PMID: 26793296 PMCID: PMC4703914 DOI: 10.4081/or.2015.6182] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 10/20/2015] [Accepted: 10/20/2015] [Indexed: 11/22/2022] Open
Abstract
Aneurysmal bone cysts are benign bone tumors that usually present in childhood and early adulthood. They usually manifest as expansile osteolytic lesions with a varying potential to be locally aggressive. Since their first description in 1942, a variety of treatment methods has been proposed. Traditionally, these tumors were treated with open surgery. Either intralesional surgical procedures or en bloc excisions have been described. Furthermore, a variety of chemical or physical adjuvants has been utilized in order to reduce the risk for local recurrence after excision. Currently, there is a shift to more minimally invasive procedures in order to avoid the complications of open surgical excision. Good results have been reported during percutaneous surgery, or the use of embolization. Recently, sclerotherapy has emerged as a promising treatment, showing effective consolidation of the lesions and functional results that appear to be superior to the ones of open surgery. Lastly, non-invasive treatment, such as pharmaceutical intervention with denosumab or bisphosphonates has been reported to be effective in the management of the disease. Radiotherapy has also been shown to confer good local control, either alone or in conjunction to other treatment modalities, but is associated with serious adverse effects. Here, we review the current literature on the methods of treatment of aneurysmal bone cysts. The indication for each type of treatment along reported outcome of the intervention, as well as potential complications are systematically presented. Our review aims to increase awareness of the different treatment modalities and facilitate decision-making regarding each individual patient.
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Affiliation(s)
- Panagiotis Tsagozis
- Section of Orthopedics, Department of Molecular Medicine and Surgery, Karolinska Institute, Sweden
| | - Otte Brosjö
- Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden
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Fibular strut graft for humeral aneurysmal bone cyst with varus deformity. INTERNATIONAL ORTHOPAEDICS 2015; 39:1391-8. [PMID: 25850529 DOI: 10.1007/s00264-015-2746-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Proximal humerus is a common site for ABC and frequently associated with varus deformity that limits shoulder abduction. A prospective study was conducted to evaluate the use of intramedullary non-vascularised autogenous fibular strut graft for reconstruction without internal fixation. METHODS A total of 20 patients (12 girls, 8 boys) were managed for proximal humeral ABC with varus deformity by extended curettage, osteotomy, intramedullary fibular graft and composite bone substitute. Their ages ranged from 10 to 17 years (average, 13.3 years). The lesion was juxtaphyseal in 16 patients and metaphyseal in 4. All cysts were active and centrally located type 2. The modified Enneking scoring system was used for final functional evaluation. Radiological assessment was done for the extent of defect healing, incorporation of the fibula and correction of the deformity. RESULTS After a mean follow-up of 41.2 months (range, 24-74) most of patients were satisfied and resumed daily activities without pain and with good range of shoulder movement. One patient complained of shoulder pain 10 months after surgery and was attributed to local recurrence. Limitation of recreational activity was experienced by one patient. There were no cases of deep infection, nerve deficit or pathological fracture. No cases of failed healing or incorporation of the fibula was detected. The improved shoulder abduction was closely related to the mean correction of the neck shaft angle. CONCLUSIONS The technique is proved to be effective in controlling disease, correcting deformity and improving function.
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Abstract
A 9-year-old boy presented with a 3-month history of cervical pain, limited range of motion, and a palpable "bump" in his posterior neck. After treatment with antibiotics for presumptive adenopathy and progression of the palpable finding, radiographs were obtained.
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Wang EHM, Marfori ML, Serrano MVT, Rubio DA. Is curettage and high-speed burring sufficient treatment for aneurysmal bone cysts? Clin Orthop Relat Res 2014; 472:3483-8. [PMID: 25048282 PMCID: PMC4182380 DOI: 10.1007/s11999-014-3809-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 07/07/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND To decrease the recurrence rate after intralesional curettage for aneurysmal bone cysts, different adjuvant treatments have been recommended. Liquid nitrogen spray and argon beam coagulation have provided the lowest recurrence rates, but unlike the high-speed burr, these adjuvants are not always available in operating rooms. QUESTIONS/PURPOSES We asked: (1) Is high-speed burring alone sufficient as an adjuvant to curettage with respect to recurrence rates? (2) What is the complication rate from this technique? (3) What are the risk factors for local recurrence? METHODS A retrospective review of the database of the University Musculoskeletal Tumor Unit and the private files of the senior author (EHW) for a period of 19 years (1993-2011) was performed to identify all patients histologically diagnosed with primary aneurysmal bone cyst. During that period, patients with aneurysmal bone cysts were treated with intralesional curettage, burring, and bone grafting if the lesions showed an adequate cortical wall or a wall with thinned out portions which could be reconstructed with bone grafting. Based on those indications, we treated 54 patients for this condition. Of those, 18 were treated using approaches other than burring because they did not meet the defined indications, and an additional five patients were lost to followup before 2 years, leaving 31 patients for analysis, all of whom were followed up for at least 2 years (mean, 7 years; range, 2-18 years). RESULTS Of these 31 patients, one had a recurrence (3.2%). Complications using this approach occurred in three patients (9.7%), and included growth plate deformity (1) and genu varus (2) secondary to collapse of the reconstructed condyle. With only one recurrence, we cannot answer what the risk factors might be for recurrence; however, the one patient with recurrence presented with a large lesion and a pathologic fracture. CONCLUSIONS Curettage, burring, and bone grafting compare favorably in the literature with other approaches for aneurysmal bone cysts, such as cryotherapy and argon-beam coagulation. We conclude that high-speed burring alone as an adjuvant to intralesional curettage is a reasonable approach to achieving a low recurrence rate for aneurysmal bone cysts. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Edward H. M. Wang
- Tumor Service, Department of Orthopaedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Taft Avenue, Ermita, 1000 Manila, Philippines
| | - Michael L. Marfori
- Department of Orthopaedics, De La Salle University Health Sciences Institute, Dasmarinas City, Philippines
| | - Ma Victoria T. Serrano
- Tumor Service, Department of Orthopaedics, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Donnel Alexis Rubio
- Tumor Service, Department of Orthopaedics, Philippine General Hospital, University of the Philippines, Manila, Philippines
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Pelle DW, Ringler JW, Peacock JD, Kampfschulte K, Scholten DJ, Davis MM, Mitchell DS, Steensma MR. Targeting receptor-activator of nuclear kappaB ligand in aneurysmal bone cysts: verification of target and therapeutic response. Transl Res 2014; 164:139-48. [PMID: 24726460 DOI: 10.1016/j.trsl.2014.03.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 03/07/2014] [Accepted: 03/11/2014] [Indexed: 01/04/2023]
Abstract
Aneurysmal bone cyst (ABC) is a benign tumor of bone presenting as a cystic, expansile lesion in both the axial and appendicular skeleton. Axial lesions demand special consideration, because treatment-related morbidity can be devastating. In similar lesions, such as giant cell tumor of bone (GCTB), the receptor-activator of nuclear kappaB ligand (RANKL)-receptor-activator of nuclear kappaB (RANK) signaling axis is essential to tumor progression. Although ABC and GCTB are distinct entities, they both contain abundant multinucleated giant cells and are osteolytic characteristically. We hypothesize that ABCs express both RANKL and RANK similarly in a cell-type specific manner, and that targeted RANKL therapy will mitigate ABC tumor progression. Cellular expression of RANKL and RANK was determined in freshly harvested ABC samples using laser confocal microscopy. A consistent cell-type-specific pattern was observed: fibroblastlike stromal cells expressed RANKL strongly whereas monocyte/macrophage precursor and multinucleated giant cells expressed RANK. Relative RANKL expression was determined by quantitative real-time polymerase chain reaction in ABC and GCTB tissue samples; no difference in relative expression was observed (P > 0.05). In addition, we review the case of a 5-year-old boy with a large, aggressive sacral ABC. After 3 months of targeted RANKL inhibition with denosumab, magnetic resonance imaging demonstrated tumor shrinkage, bone reconstitution, and healing of a pathologic fracture. Ambulation, and bowel and bladder function were restored at 6 months. Denosumab treatment was well tolerated. Post hoc analysis demonstrated strong RANKL expression in the pretreatment tumor sample. These findings demonstrate that RANKL-RANK signal activation is essential to ABC tumor progression. RANKL-targeted therapy may be an effective alternative to surgery in select ABC presentations.
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Affiliation(s)
- Dominic W Pelle
- Laboratory of Musculoskeletal Oncology, Center for Skeletal Disease and Tumor Metastasis, Van Andel Institute, Grand Rapids, Mich; Department of Orthopaedic Surgery, Grand Rapids Medical Education Partners, Grand Rapids, Mich.
| | - Jonathan W Ringler
- Laboratory of Musculoskeletal Oncology, Center for Skeletal Disease and Tumor Metastasis, Van Andel Institute, Grand Rapids, Mich
| | - Jacqueline D Peacock
- Laboratory of Musculoskeletal Oncology, Center for Skeletal Disease and Tumor Metastasis, Van Andel Institute, Grand Rapids, Mich
| | - Kevin Kampfschulte
- Laboratory of Musculoskeletal Oncology, Center for Skeletal Disease and Tumor Metastasis, Van Andel Institute, Grand Rapids, Mich
| | - Donald J Scholten
- Laboratory of Musculoskeletal Oncology, Center for Skeletal Disease and Tumor Metastasis, Van Andel Institute, Grand Rapids, Mich; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - Mary M Davis
- Department of Pathology, Spectrum Health Medical Group, Grand Rapids, Mich
| | - Deanna S Mitchell
- Department of Pediatric Hematology-Oncology, Helen DeVos Children's Hospital, Grand Rapids, Mich
| | - Matthew R Steensma
- Laboratory of Musculoskeletal Oncology, Center for Skeletal Disease and Tumor Metastasis, Van Andel Institute, Grand Rapids, Mich; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Mich; Department of Surgery, Spectrum Health Medical Group/ Helen DeVos Children's Hospital, Grand Rapids, Mich
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Reddy KIA, Sinnaeve F, Gaston CL, Grimer RJ, Carter SR. Aneurysmal bone cysts: do simple treatments work? Clin Orthop Relat Res 2014; 472:1901-10. [PMID: 24532435 PMCID: PMC4016447 DOI: 10.1007/s11999-014-3513-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 02/05/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Primary aneurysmal bone cysts (ABCs) are benign, expansile bone lesions commonly treated with aggressive curettage with or without adjuvants such as cryotherapy, methacrylate cement, or phenol. It has been reported that occasionally these lesions heal spontaneously or after a pathologic fracture, and we observed that some ABCs treated at our center healed after biopsy alone. Because of this, we introduced a novel biopsy technique we call "curopsy," which is a percutaneous limited curettage at the time of biopsy, obtaining the lining membrane from various quadrants of the cyst leading to consolidation (curopsy = biopsy with intention to cure). QUESTIONS/PURPOSES We asked whether (1) a curopsy results in comparable likelihood of healing of the ABC compared with more aggressive approaches involving curettage, (2) the two approaches differ in terms of the likelihood of recurrence after treatment, and (3) the two approaches differ in terms of complications after surgery. METHODS Between January 1, 1999 and June 30, 2012, 221 patients with a diagnosis of primary ABC were registered in our oncology database. Patients presenting with a pathologic fracture and those seeking a second opinion were excluded. One hundred ninety patients were included in the study. One hundred two (54%) were treated with curopsy and 88 (46%) were treated with curettage after a core needle biopsy. Complete followups were available for 88% (90 of 102) and 93% (80 of 88) of patients in those groups, respectively. During that period, a curopsy was performed for all patients with benign bone lesions with imaging suggestive of classic primary ABCs and for whom the core needle biopsy simply showed blood with no solid component. Curettage after a core needle biopsy was reserved for histologically confirmed primary ABCs, lesions with impending fractures, large lesions, if the ABC was thought to be a secondary disorder, and patients for whom the curopsy failed. All patients were followed up until consolidation of the lesion (mean, 9.6 weeks, range, 3-25 weeks, 95% CI, 8.32-10.9 for curopsy; mean, 11.4 weeks, range, 8-32 weeks, 95% CI, 10.6-12.3 for curettage). The median followup for all patients was 14 months (range, 6-36 months). RESULTS Of the 102 patients who had curopsy and observation, 83 (81%) required no additional treatment and the lesion resolved. Of the 88 patients who underwent curettage (with or without adjuvant therapy) after core needle biopsy, the success rate was 90% (79 of 88). Local recurrences in both groups (curopsy or curettage) were treated successfully with additional curettage in all but one case. Curopsy in comparison to curettage provided a mean shorter healing time (9.6 versus 11.4, p = 0.01) but there was a higher local recurrence and need for additional intervention rate (18.6% versus 10.2%, p = 0.04). There were no differences in the complications between the treatment groups. CONCLUSIONS A curopsy is a novel biopsy technique that was successful in resolving ABCs in 81% of the patients in our study. Curopsy, as a biopsy technique, for ABCs needs consideration as it potentially minimizes the number of patients needing a second procedure (a core needle biopsy being the first) as is the current practice. Furthermore, it does not disadvantage the patient or surgeon should additional intervention be needed in the form of curettage with or without adjuvants. LEVEL OF EVIDENCE Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Krishna I. A. Reddy
- />The Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP UK
| | - F. Sinnaeve
- />Department of Oncologic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Czar Louie Gaston
- />The Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP UK
| | - Robert J. Grimer
- />The Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP UK
| | - Simon R. Carter
- />The Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP UK
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Abstract
Aneurysmal bone cyst (ABC) is a benign lesion that commonly involves the metaphysis or metadiaphyseal region of long bones in children. The WHO defined ABC as an expansile osteolytic lesion consisting of blood-filled spaces and channels that are divided by connective tissue septa that may contain osteoid tissue and osteoclast-like giant cells. ABCs are usually treated with intralesional procedures, and variables including surgeon technique, young patient, juxtaphyseal tumors, and tumor location have been associated with recurrence. Juxtaphyseal lesions breaching the physis have been described. There is only one case of primary ABC of the epiphysis in the literature. We present a second case in a 13-year-old boy who presented with a primary ABC of the distal tibial epiphysis, including diagnostic evaluation and treatment.
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Bipolar electric cauterization as adjuvant treatment after curettage of aneurysmal bone cysts of the hand. Ann Plast Surg 2013; 72:38-40. [PMID: 24317236 DOI: 10.1097/sap.0000000000000000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Almost all aneurysmal bone cysts of the hand were managed with either simple curettage plus or minus bone graft or en block excision and autograft reconstruction. The high recurrence rate is a major disadvantage of the former technique, whereas complexity/donor-site morbidities are known disadvantages of the latter technique. In the long bones of the lower limbs, adjuvant therapy after curettage is known to reduce the recurrence rate. This article introduces adjuvant bipolar electrical cauterization after curettage of aneurysmal bone cysts of the hands. This technique was used in 6 cases including 1 case with a recurrent lesion after curettage done elsewhere. Complications have been minimal and there was no recurrence at a mean follow-up of 3 years. Although the number of cases in this series is small, the favorable results warrant trying the technique in a multicenter comparative study.
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Flont P, Kolacinska-Flont M, Niedzielski K. A comparison of cyst wall curettage and en bloc excision in the treatment of aneurysmal bone cysts. World J Surg Oncol 2013; 11:109. [PMID: 23701661 PMCID: PMC3669013 DOI: 10.1186/1477-7819-11-109] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 05/12/2013] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The recurrence rate after aneurysmal bone cyst (ABC) treatment is quite high despite its benign nature. In ABC therapy, curettage is the treatment of choice; en bloc excision results in a lower recurrence rate, but more extensive reconstructive surgery is needed with associated morbidity. The aim of the present study was to compare the outcomes of the two treatment options. METHODS A retrospective analysis was performed on 26 patients treated for ABCs: 16 by curettage and 10 by en bloc excision. Each lesion was classified according to Enneking and patients were followed up for a mean time of 9.2 years. On follow-up, radiological examination and functional assessment (range of motion, muscle strength) were performed. Recurrence was defined as the presence of an osteolytic lesion, especially one with a tendency to grow. RESULTS On follow-up, the following symptoms were more prevalent in the en bloc excision group compared to the curettage group: pain (en bloc 20% versus curettage 6.25%), limb length differences (en bloc 20% versus curettage 12.5%), reduced range of motion (en bloc 20% versus curettage 6.25%) and muscle strength impairment (en bloc 50% versus curettage 31.2%); however, the differences were not statistically significant (P >0.05). In the curettage group, two cases of postoperative complications and two cases of recurrence were seen, while in the en bloc excision group one case of complications was noted. CONCLUSIONS Curettage is a standard procedure in ABC management. En bloc excision is another option, albeit more technically demanding, that may be considered in recurrent lesions with extensive bone destruction or for cysts in an expendable location.
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Affiliation(s)
- Pawel Flont
- Clinic of Orthopaedic and Traumatology, Polish Mother's Memorial Hospital Research Institute, Lodz 93-338, Poland.
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Joint preservation reconstruction for treatment of recurrent juxtaphyseal upper tibial aneurysmal bone cyst using Ilizarov external fixator. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e318267fad4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Steffner RJ, Liao C, Stacy G, Atanda A, Attar S, Avedian R, Peabody TD. Factors associated with recurrence of primary aneurysmal bone cysts: is argon beam coagulation an effective adjuvant treatment? J Bone Joint Surg Am 2011; 93:e1221-9. [PMID: 22048101 DOI: 10.2106/jbjs.j.01067] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Our goal was to assess the effectiveness and safety of argon beam coagulation as an adjuvant treatment for primary aneurysmal bone cysts, to reevaluate the adjuvant effectiveness of the use of a high-speed burr alone, and, secondarily, to identify predictors of aneurysmal bone cyst recurrence. METHODS We retrospectively reviewed the records of ninety-six patients with primary aneurysmal bone cysts who were managed at our institution from January 1, 1983, to December 31, 2008. Forty patients were managed with curettage, a high-speed burr, and argon beam coagulation; thirty-four were managed with curettage and a high-speed burr without argon beam coagulation; and the remaining twenty-two were managed with curettage with argon beam coagulation alone, curettage with no adjuvant treatment, or resection of the entire lesion. Demographic, clinical, and radiographic data were viewed comparatively for possible predictors of recurrence. Kaplan-Meier survival analysis with a log-rank test was performed to measure association and effectiveness. RESULTS The median age at the time of diagnosis was fifteen years (range, one to sixty-two years). The median duration of follow-up was 29.5 months (range, zero to 300 months). The overall rate of recurrence of aneurysmal bone cyst after surgical treatment was 11.5%. The rate of recurrence was 20.6% after curettage and high-speed-burr treatment alone and 7.5% after curettage and high-speed-burr treatment plus argon beam coagulation. The five-year Kaplan-Meier survival estimate was 92% for patients managed with curettage and adjuvant treatment with a high-speed burr and argon beam coagulation, compared with 73% for patients managed with curettage and a high-speed burr only (p = 0.060). CONCLUSIONS Surgical treatment of aneurysmal bone cyst with curettage and adjuvant argon beam coagulation is effective. Postoperative fracture appears to be a common complication of this treatment and needs to be studied further. Treatment with curettage and high-speed burr alone may not reduce recurrence.
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Donati D, Frisoni T, Dozza B, DeGroot H, Albisinni U, Giannini S. Advance in the treatment of aneurysmal bone cyst of the sacrum. Skeletal Radiol 2011; 40:1461-6. [PMID: 21626181 DOI: 10.1007/s00256-011-1202-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 05/04/2011] [Accepted: 05/09/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study was the review of 11 patients with two different treatment methods used historically for aneurysmal bone cyst in the sacrum. The outcome of both procedures is reported. In addition, the treatment technique of CT-guided percutaneous injections of demineralized bone matrix mixed with bone marrow concentrate is described. MATERIALS AND METHODS From 1997 to 2008, 11 patients with sacral aneurysmal bone cyst were treated at the Rizzoli Institute, Bologna, Italy. The first seven patients had surgical curettage without bone grafting, chemical adjuvants, or arterial embolization. The last four patients had arterial embolization. The last patient did not respond to arterial embolization and was treated by CT-guided injection of demineralized bone matrix mixed with bone marrow concentrate. RESULTS Curettage was successful in five out of seven patients. Two patients suffered complications, and two cases had recurrence. Arterial embolization was successful in three of four patients. The patient treated with injection had a good clinical and radiographic result. CONCLUSION Both surgical and arterial embolization are effective for aneurysmal bone cyst in the sacrum. However, these treatments may lead to complications and recurrence. The use of CT-guided injections of demineralized bone matrix mixed with bone marrow concentrate may be a safe and effective alternative for treatment of these destructive and problematic lesions.
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Affiliation(s)
- Davide Donati
- II Orthopaedic and Traumatology Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy.
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Abstract
Bone tumors are uncommon clinical entities that are often a source of diagnostic and therapeutic uncertainty. Evaluating these lesions starts with a patient history and physical examination Imaging then begins with radiographs, followed by advanced imaging modalities, such as magnetic resonance imaging, computed tomography, or bone scan. Biopsy can be performed to establish histologic diagnosis by either closed or open means. Treatment options range from observation to wide resection with reconstruction or amputation. Surveillance schedules vary depending on the type of tumor that is being treated. An algorithm for the evaluation, work-up, and diagnosis of bone tumors is presented.
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Affiliation(s)
- Tessa Balach
- Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-5456, USA
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