ABSTRACT
Se presenta el caso de un paciente con quistes en el hueso iliaco como causa atípica de lumbalgia crónica a la cual se puede enfrentar el reumatólogo, y se hará una revisión de la literatura sobre los tipos de quistes óseos y sus diagnósticos diferenciales. También se hará mención de sus opciones de tratamiento.
The case of a patient with cysts in the iliac bone is presented as an atypical cause of chronic low back pain that the rheumatologist may face, and a review of the literature on the types of bone cysts and their differential diagnoses will be made. Mention will also be made of your treatment options.
Subject(s)
Low Back Pain , Therapeutics , Bone Cysts , Back Pain , Cysts , Diagnosis, DifferentialABSTRACT
is no expansion of the bone with unicameral bone cysts but in our present case there was expansion making it atypical presentation. We present a 22-year male who underwent MRI for Lumbosacral spine for his vague low backache symptoms. There was incidental finding of bony lesion in left iliac bone which turned out to be simple bone cyst. The study of Lumbosacral spine was unremarkable.
ABSTRACT
BACKGROUND: The treatment of simple bone cysts (SBC) in children varies significantly among physicians. This study examined which procedure is better for the treatment of SBC, using a decision analysis based on current published evidence. METHODS: A decision tree focused on five treatment modalities of SBC (observation, steroid injection, autologous bone marrow injection, decompression, and curettage with bone graft) were created. Each treatment modality was further branched, according to the presence and severity of complications. The probabilities of all cases were obtained by literature review. A roll back tool was utilized to determine the most preferred treatment modality. One-way sensitivity analysis was performed to determine the threshold value of the treatment modalities. Two-way sensitivity analysis was utilized to examine the joint impact of changes in probabilities of two parameters. RESULTS: The decision model favored autologous bone marrow injection. The expected value of autologous bone marrow injection was 0.9445, while those of observation, steroid injection, decompression, and curettage and bone graft were 0.9318, 0.9400, 0.9395, and 0.9342, respectively. One-way sensitivity analysis showed that autologous bone marrow injection was better than that of decompression for the expected value when the rate of pathologic fracture, or positive symptoms of SBC after autologous bone marrow injection, was lower than 20.4%. CONCLUSIONS: In our study, autologous bone marrow injection was found to be the best choice of treatment of SBC. However, the results were sensitive to the rate of pathologic fracture after treatment of SBC. Physicians should consider the possibility of pathologic fracture when they determine a treatment method for SBC.
Subject(s)
Humans , Analysis of Variance , Bone Cysts/surgery , Bone Marrow Transplantation/methods , Decision Trees , Practice Guidelines as Topic , Transplantation, AutologousABSTRACT
Introduction: Simple bone cyst or unicameral bone cysts are benign osteolytic lesions seen in metadiaphysis of long bones in growing children. Various treatment modalities with variable outcomes has been described in the literature. Case report show novel surgical technique of minimally invasive method of treatment with better outcome. Case study: A 14-year-old boy diagnosed as active simple bone cyst proximal humerus with pathological fracture. Patient was treated by minimally invasive percutaneous curettage with curved titanium elastic nail (TENS) and allogenic bone grafting mixed with bone marrow under image intensifier guidance. Results: Pathological fracture was healed and allograft filled in the cavity well taken-up. Patient achieved full range of motion with successful outcome. Conclusion: Minimally invasive percutaneous method using elastic intramedullary nail give benefit of curettage cyst decompression and stabilization of fracture. Allogenic bone graft fills the cavity and healing of lesion occurs by osteointegration. This method may be considered with advantage of minimally invasive technique in treatment of benign cystic lesions of bone. Level of evidence: Therapeutic level IV.
ABSTRACT
PURPOSE: The present study aims at evaluating our results of intramedullary decompression of the unicameral bone cysts in children with using flexible nail(s) or titanium cannulated screws. MATERIALS AND METHODS: We treated fourteen children with unicameral bone cysts by intramedullary decompression. Eleven cases were in the metaphysis of long bones (seven in the proximal humerus amd four were in the proximal femur), which were all treated by flexible intramedullary nailing; while a cancellous screw was axially placed in three cysts of the short bones (all in the calcaneus). The mean age of the patients at the time of surgery was 11.8 years, and the mean duration of follow-up was 16.7 months. The final outcome was radiographically classified into the four categories of Capanna et al.,; completely healed, healed with residual radiolucency, recurred or having no response. RESULTS: All of the cysts In the long bones responded to treatment. Seven cysts healed completely, and three healed with residual radiolucent areas visible on radiographs. One cyst, which initially appeared completely healed, recurred after the removal of nails. The healing period varied from three to 36 months. For the calcaneal cysts, there was no definite sign of effective consolidation in all three cases. CONCLUSION: Intramedullary decompression by flexible nailing for the treatment of unicameral bone cyst of a long bone was effective in providing early stability and for accelerating consolidation of the cyst. Its surgical intervention is minimal, and the result is predictable. Our trial of placing a screw in the calcaneal cysts was unsuccessful according to the short term follow-up.
Subject(s)
Child , Humans , Bone Cysts , Decompression , Follow-Up Studies , Humerus , Nails , TitaniumABSTRACT
Unicameral bone cysts have been treated by variable surgical methods, but reported with high recurrent rates. Recently, the treatment of unicameral bone cyst by topical injection of methylprednisolone acetate has been reported with excellent results. The authors treated 4 cases of the unicameral bone cyst by topical injection of methylprednisolone acetate and followed up for 3 years and 5 months to 4 years. The results were as follows: l. 3 cases were healed completely with obliteration of cyst cavity and 1 case was in residual healing process. 2. If the cavity persists or recurrs, it seems possible to cure the cyst by repeated local injection.