Background: Bone cysts are osteolytic, benign, fluid-filled bone lesions mostly seen before skeletal maturity. Various treatment modalities have been described in the literature with variable outcomes but there is no consensus regarding the best procedure. Traditional bone grafting techniques have given way to newer cell-based therapies that are potentially less invasive with less complications and early recovery. The less invasive, percutaneous injection can be used with different materials such as steroids, bone marrow or bone graft substitutes to optimize results. Bone marrow contains the osteoprogenitor cells, various bone morphogenetic proteins, growth factors and other signaling molecules that provide the appropriate environment for direct new bone formation.
Aim of the work: Evaluating the role of repeated autologous bone marrow injection in treatment of different types of bone cysts in patients bellow the age of skeletal maturity regarding the healing time, the occurrence of pathological fractures and recurrence after healing.
Patients and Methods: 20 patients who had accidentally discovered, un-complicated bone cysts were included in this prospective case series study. All patients were bellow the age of skeletal maturity. patients were evaluated clinically and radiologically before surgery. All patients were treated by three successive injections (at 3 weeks intervals) of autologous bone marrow aspirated from their iliac crests and injected in the cystic lesions under image intensifier. Patients were followed up for a mean time of 26 months post-operatively.
Results: The results were successful in 18 patients (90 % of the studied patients) with a mean healing time of 15.4 weeks. 15 cases (75 % of the studied patients) had completely healed cysts and were graded as ( Neer's I ) while 3 cases (15 % of the studied patients) healed with small defects and were graded as ( Neer's II ) with good functional and radiological results. Only 2 cases (10 % of the studied patients) had recurrence and were considered as failure ( Neer's IV ).
Conclusion: The satisfactory clinical and radiographic results of this study support the use of percutaneous autologous bone marrow injection as one of the treatment options in management of different types of bone cysts in patients below the age of skeletal maturity as an easy, safe, simple and effective treatment method. Repeated injections improve the healing rate and shorten the healing time. |
