Bone marrow injection for the treatment of bone cysts before skeletal maturity

Abstract

Background Bone cysts are benign, osteolytic, fluid-filled bone lesions mostly seen before skeletal maturity. Various treatment modalities with variable outcomes have been described in the literature, but there is no consensus as regards the best procedure. Traditional bone grafting techniques have given way to newer cellular therapies that are potentially less invasive and have a lower complication rate and faster recovery time. The percutaneous method can be used with different materials such as bone marrow (BM) or bone substitutes to optimize results. BM contains the osteoprogenitor cells, various bone morphogenetic proteins, growth factors, and other signaling molecules that provide the appropriate environment for bone formation and remodeling. Aim The aim of this study was to evaluate the role of autologous BM injection in the treatment of different types of bone cysts in children below the age of skeletal maturity as regards the healing time, the occurrence of pathological fractures, and recurrence after healing. Patients and methods Totally, 20 patients with accidentally discovered, uncomplicated bone cysts of different types were included in this prospective case series study. All patients were below the age of skeletal maturity. Patients were evaluated clinically and radiologically before surgery. All cases were treated with three repeated injections (at 3 weeks’ intervals) of BM 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 postoperatively. Results The results were successful in 18 patients (90% of the studied patients), with a mean healing time of 15.4 weeks. Totally, 15 cases (75% of the studied patients) had completely healed and were graded as Neer I, whereas three cases (15% of the studied patients) healed with small defects and were graded as Neer II, with good functional and radiological results. Only two cases (10% of the studied patients) had recurrence and were considered as failure (Neer IV). Conclusion The satisfactory clinical and radiographic results of this study support the use of percutaneous autologous BM injection as one of the treatment options in the management of cases with bone cysts of different types in patients below the age of skeletal maturity as an easy, safe, simple, and effective treatment method. Repeated injections improve healing rate and shorten the healing time.