Dominic Puthoor1, Leo Francis2, Rashik Ismail3. 1. Orthopaedic Oncologist, Professor and Head, Dept. of Orthopaedics, Amala Institute of Medical Sciences, India. 2. Assistant Professor, Dept. of Orthopaedics, Amala Institute of Medical Sciences, Thrissur, Kerala, 680555, India. 3. Dept. of Orthopaedics, Amala Institute of Medical Sciences, India.
Abstract
BACKGROUND: The standard treatment of Aneurysmal bone cyst is curettage and grafting and is associated with high morbidity. Hence minimal invasive alternative treatment methods such as sclerotherapy are gaining much popularity. Though sclerotherapy has been attributed to reasonable cure rates, undetermined tissue diagnosis often impedes with initiation of treatment. This study examines if sclerotherapy with polidocanol based on clinic-radiological picture is comparable with the standard intralesional curettage and bone grafting. Attempting biopsy and treatment simultaneously based on the clinico-radiological presentation makes this study unique. METHODS: We divided 48 patients into two treatment groups. Group 1 treated with percutaneous sclerotherapy using polidocanol and group 2 those treated with extended curettage and bone grafting. We assessed time to healing and recurrence, pain relief, and radiological outcome using modified Neer's criteria for the radiological healing of the bone cysts. 31 patients from Group 1 and 17 from Group 2 were available for study. The minimum follow-up was 2 years. RESULTS: At last follow-up, 100% in Group 1 and 82% in Group 2 had achieved complete healing and there was no statistical difference in outcome at 24 months (p = 0.255). Complications in Group 1 were injection site necrosis, pain and hypopigmentation, all of which resolved spontaneously. In Group 2, three patients had recurrence. Despite similar healing rates, we found higher incidence of clinically pertinent complications, poor functional outcomes and increased cost of treatment associated with intralesional excision.Three cases were excluded from sclerotherapy group as the final diagnosis turned up to be secondary ABC. CONCLUSIONS: Percutaneous sclerotherapy using polidocanol is a highly effective, cost efficient and safe treatment option with good cosmesis and reduced morbidity. In this study, we found comparable outcomes for both treatment methods however this will require confirmation in larger studies.
BACKGROUND: The standard treatment of Aneurysmal bone cyst is curettage and grafting and is associated with high morbidity. Hence minimal invasive alternative treatment methods such as sclerotherapy are gaining much popularity. Though sclerotherapy has been attributed to reasonable cure rates, undetermined tissue diagnosis often impedes with initiation of treatment. This study examines if sclerotherapy with polidocanol based on clinic-radiological picture is comparable with the standard intralesional curettage and bone grafting. Attempting biopsy and treatment simultaneously based on the clinico-radiological presentation makes this study unique. METHODS: We divided 48 patients into two treatment groups. Group 1 treated with percutaneous sclerotherapy using polidocanol and group 2 those treated with extended curettage and bone grafting. We assessed time to healing and recurrence, pain relief, and radiological outcome using modified Neer's criteria for the radiological healing of the bone cysts. 31 patients from Group 1 and 17 from Group 2 were available for study. The minimum follow-up was 2 years. RESULTS: At last follow-up, 100% in Group 1 and 82% in Group 2 had achieved complete healing and there was no statistical difference in outcome at 24 months (p = 0.255). Complications in Group 1 were injection site necrosis, pain and hypopigmentation, all of which resolved spontaneously. In Group 2, three patients had recurrence. Despite similar healing rates, we found higher incidence of clinically pertinent complications, poor functional outcomes and increased cost of treatment associated with intralesional excision.Three cases were excluded from sclerotherapy group as the final diagnosis turned up to be secondary ABC. CONCLUSIONS: Percutaneous sclerotherapy using polidocanol is a highly effective, cost efficient and safe treatment option with good cosmesis and reduced morbidity. In this study, we found comparable outcomes for both treatment methods however this will require confirmation in larger studies.
Authors: A H Mahnken; C C A Nolte-Ernsting; J E Wildberger; N Heussen; G Adam; D C Wirtz; W Piroth; A Bücker; S Biesterfeld; P Haage; R W Günther Journal: Eur Radiol Date: 2002-10-03 Impact factor: 5.315