Treatment of Aneurysmal Bone Cysts by Minimally Invasive Curettage and Allogenic Bone Impaction Grafting: Mid‐to Long‐term Results

Abstract

Objective: Recurrence is the main hinderance in treatment of aneurysmal bone cysts (ABCs). Therefore, several treatment modalities and adjuvant therapies have been proposed. In this study, we aim to evaluate the long-term effectiveness of percutaneous curettage and allogenic bone grafting as a new, minimally invasive modality in treating ABCs. Methods:We performed a retrospective review of the medical records of patients diagnosed with primary ABCs at a university hospital over a 10-year period (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). We selected all patients who were diagnosed with primary ABC in the extremities and pelvis, treated with the same surgical procedure, and were followed for at least 2 years postoperatively. All patients underwent the same procedure of percutaneous curettage and impaction of allogenic pulverized fine bone fragments (harvested from locally stored femoral heads) mixed with autologous bone marrow aspirate from the iliac bone. We reported patient's characteristics (age and gender), site and size of the lesion, presenting symptoms, Capanna classification, follow-up duration, and post-operative complications. Assessment of cyst healing was based on the appearance on radiographs according to the modified Neer classification.Results: Nineteen patients were included in this study; 10 patients were males and nine were females. The mean age was 9.6 years (range 3-15). The location of the lesions was as follows: femur (eight), tibia (four), pelvis (four), proximal humerus (one), distal radius (one), and calcaneus (one). The most common presenting symptom was pain in the involved area. Pathological fracture was the presenting feature in two patients. The mean follow-up duration was 6.4 years (range 2-18). The earliest radiological sign of incorporation of the allograft was seen at 3 months after surgery. All patients showed bone remodeling and radiographic resolution (classified as either A or B on the modified Neer classification) of their cystic lesions within 6 months. No local recurrence, infection, or pathological fractures occurred during the follow-up period. Conclusion:Percutaneous curettage and impaction of allogenic bone graft mixed with autogenic bone marrow aspirate is an efficient, minimally invasive, reproducible, and affordable procedure for the treatment of primary ABCs.

Restoration of Limb Length Discrepancy and Alignment With the Ilizarov Device After Management of an Aneurysmal Bone Cyst Crossing the Distal Femoral Physis

“…Rapid recurrence has been reported after discontinuation of denosumab [ 19 , 20 ]. Intralesional curettage can be performed through minimally invasive surgery or even with arthroscopic assistance [ 21 , 22 ].…”

“…The cyst reduced in size, and remarkable cortical regeneration was observed in the bones of the distal femur. Neer CS et al have proposed a classification system for assessing the healing of the cyst post-treatment, comprising four types [ 21 - 24 ]. Our patient exhibited healing with a radiolucent defect area of less than 50% of the diameter and adequate bone thickness, allowing her to partake in all activities without risk of fracture (Type II, healed cyst with a defect).…”

Autogenous fibula head transplantation for aneurysmal bone cyst of distal radius: A case report followed up for 7 years

“…[ 10 ] However, all non-block resection treatments have a risk of local recurrence. [ 11 ] In this case, the patient was a 28-year-old female patient with ABC. Because the tumor is large and has affected the movement of the joint, we estimate that the effect of conventional treatment is limited and can easily recur, so we drew up a plan for surgical resection of the tumor and wrist reconstruction at the same time.…”

Tripod-Fix device for the treatment of painful osteoporotic vertebral compression fractures

“…[2] Initially introduced by Galibert et 1998. [7][8][9] The advantage of balloon kyphoplasty (BKP) offers the advantage of balloon inflationis the ability of the inflation of the balloon to create a greater volume, which can reduce the injection pressure and minimize the risk of bone cement leakage.the risk of bone cement leakage. [10,11] NonethelessNevertheless, the period of the deflation of the balloon deflation during the procedure can potentiallycan lead to partial or complete collapse of the vertebral body collapse.…”