Treatment of bone cysts by percutaneous injection of demineralized bone matrix mixed with bone marrow

Abstract

Bone cysts whether aneurysmal or simple, are known for their tendency to recur. To replace the classical aggressive surgeries, minimally invasive techniques were developed giving differing results based on variable radiographic criteria. No unique percutaneous treatment has proven effective on both types of cysts. The purpose of this study was to evaluate with volumetric MRI calculations the benefit of percutaneous injection of demineralized bone matrix mixed with autogenous bone marrow on both types of cysts. Twenty-seven cysts; 6 aggressive aneurysmal bone cysts (ABCs) and 21 active simple bone cysts (SBCs) were treated with our percutaneous treatment in this case series. Regular MRIs were performed to calculate their volumetric evolution starting before treatment and with a minimal two-year follow-up. A cyst was considered healed when its final residual volume shrank to less than 50%. To allow statistical comparison between both types of cysts, 13 previously reported ABCs treated with the same protocol in our institution were joined to the 6 present ABCs. Four ABCs healed with a single injection while the 2 others recurred. Five SBCs healed with a single injection, 9 others after a second injection and 2 others after a third injection. Five SBCs were considered non-healed. The present healing rate in 67% of ABCs is consistent with the previous series as there was no significant difference (p=0.37). The better global healing rate for ABC (79%) was not statistically different from the SBC healing rate (76%) (p=0.83). The percutaneous injection of demineralized bone matrix mixed with bone marrow is an effective treatment for both types of cysts.