Bone cyst
– a disease characterized by the formation of a cavity in human bone tissue. The process of impaired blood circulation in the bone entails the activation of pathogenic substances that destroy the bone structure, which ultimately leads to the formation of a cyst. As the cavity grows, it fills with liquid. These pathologies can occur in both children and adults, but are more common in children between 10 and 15 years of age.
Causes of bone cysts.
The causes of bone cysts have not yet been studied in detail. The disease can appear as a result of previous injuries (dislocations, falls, bruises, etc.). It also affects people suffering from rheumatoid arthritis, osteoarthritis and chronic gout. Bone cysts increase the risk of developing fractures because... when they form, the volume of bone tissue decreases, and the bones can no longer withstand the previous load and break easily.
The disease can be asymptomatic for a long time and be discovered accidentally during a fracture or during an X-ray examination for another reason. Sometimes a bone cyst can cause swelling and pain.
conclusions
Since no single protocol has been developed for the choice of treatment method for children and adolescents with tumors and tumor-like diseases, the course of which was complicated by pathological fractures, each case requires a differentiated approach to treatment and depends on the nature, location of the fracture, as well as the age of the patient and the nosological affiliation of the underlying disease, which must be confirmed morphologically.
Information about authors
For contacts:
Snetkov A.I. — email
Treatment of bone cysts
The conservative treatment method includes a course of therapeutic punctures (two needles are inserted into the body of the cyst, with the help of which fluid is sucked out, medications are administered to reduce bone destruction), the application of a plaster cast (if there is a fracture), physiotherapeutic treatment, and a course of therapeutic exercises. If there is no result from conservative treatment, the patient undergoes surgical treatment.
Neglect of the disease and lack of necessary treatment can lead to destruction and death of bone tissue, which may entail complete removal of the damaged part.
Aseptic bone necrosis
- a disease in which death (necrosis) of bone areas and bones as a whole occurs as a result of disruption or complete cessation of blood flow in a certain area of the bone. Idiopathic aseptic necrosis develops spontaneously without any particular reason. There are complete and partial necrosis of the bone, and also a distinction is made between superficial and deep necrosis depending on its location in the bone. The disease occurs in several stages.
Discussion
When a pathological fracture occurs, the doctor first of all faces the following questions: how will this complication affect the course of the underlying disease and what treatment tactics should be used in each specific case? Today, there are completely opposite approaches to the treatment of pathological fractures.
According to many authors [6–15], in 7–15% of cases, in patients who have suffered a pathological fracture due to a cyst, self-healing occurs—the closure of the cystic cavity. This is explained by post-traumatic drainage of the cyst cavity through the fracture line, a simultaneous decrease in intraosseous pressure, which can remain low for a long period, especially with significant displacement of bone fragments. J. Farber and R. Stanton [16] presented data on spontaneous resolution of solitary bone cysts in every 4th case of pathological fracture. In this regard, the proposed method of conservative treatment consists of long-term immobilization of the damaged limb and dynamic monitoring of the area of cystic transformation in anticipation of self-healing or reduction in the volume of the pathological cavity. J. Ahn and J. Park [17] conducted a retrospective analysis of the treatment of 52 children with pathological bone fractures due to solitary cysts and found that in the vast majority of cases the cyst persists and sometimes increases. According to the authors of this study [29], out of 42 patients with pathological fractures associated with bone cysts, repair was noted in only 1.
To stabilize and heal pathological fractures, as well as prevent fractures and heal bone cysts in adolescents after puncture biopsy, cannulated screws [18] or intraosseous Eder rods are used to avoid external immobilization [19].
At the same time, N.A. Sholokhova [20], having analyzed the results of treatment of more than 80 patients with bone cysts, came to the conclusion that a pathological fracture against the background of bone cysts does not help reduce intraosseous pressure and close the pathological focus. It is also inappropriate to use metal structures (cannulated screws and rods) in the treatment of bone cysts due to the fact that these techniques do not affect the pathogenesis of the disease.
According to S.T. Zatsepin [2], when treating pathological fractures against the background of giant cell tumors, it is necessary to postpone surgical intervention for 2 weeks from the moment of the fracture, since during a fracture, blood coagulation sharply increases, which will lead to inevitable extensive blood loss during surgery. Method of D. Alkalay et al. [21] involves a two-stage operation: at the first stage, reposition after curettage and minimal internal fixation are performed, at the second stage, repeated curettage, cryotreatment of the cavity, cementation and stable osteosynthesis are performed.
A.V. Ivanov et al. [22], taking into account that chondromas of the phalanges of the hands and feet are often diagnosed with fractures, they suggest immediately using excochleation or resection of the tumor, replacing the defect with auto- or allografts with metal osteosynthesis with miniplates. I.A. Karpenko et al. [23] believe that a two-stage method is most appropriate for treating patients with these pathologies: the first stage is the application of a distraction device for the purpose of repositioning the fracture, the second stage is intralesional resection with bone grafting.
When treating pathological fractures against the background of fibrous dysplasia, most authors give preference to surgical treatment—fracture reposition, removal of the pathological focus, and stable fixation [24]. However, R. Wirbel et al. [25] describe a case of healing of a pathological fracture and osteofibrous dysplasia within 10 months in a 4.5-year-old child after intraosseous osteosynthesis with a titanium rod.
The authors quite rightly highlight possible risks that contribute to the occurrence of pathological fractures and advise the use of metal osteosynthesis of the affected segment in order to prevent them [26].
So, for example, V.M. Shapovalov et al. [27] in the presence or risk of a pathological fracture due to benign tumors, combine bone grafting with stable internal fixation.
At the same time, S.T. Zatsepin [2] in patients with benign lesions, including complicated pathological fractures, after extensive intralesional resection, recommends performing bone grafting with fresh frozen cortical allografts with fixation on the axial graft.
L.M. Kuftyrev et al. [28] give preference to intraosseous resection of the focus of destruction, followed by free autoplasty from the iliac wing and fixation with the Ilizarov apparatus.
Thus, today, issues regarding means of fixation of pathological fractures and methods for replacing post-resection defects remain debatable. There is also no consensus on methods for preventing the occurrence of pathological fractures in patients with benign tumors and tumor-like diseases.
Diagnosis of diseases.
Bone cysts and necrosis can be diagnosed using the following methods:
- Examination by a doctor (collection of complaints, palpation of the sore spot)
- X-ray of the affected bone in several projections
- Computed tomography (CT) or magnetic resonance imaging (MRI)
- Puncture (for bone cysts, contents are taken for examination)
- Blood tests (to identify concomitant pathologies)
What is a knee cyst? Symptoms and treatments
While there is nothing eternal in the world - everything is subject to wear, aging and damage. The human body is no exception. In particular, the knee joint. This part of the body is an anatomical structure that allows various types of leg movements. Unfortunately, diseases can develop in such an important node for humans. One of them is a cyst.
general information
What it is? If you look from the outside, it's a tumor. There is an accumulation of fluid inside the knee, which leads to the appearance of tumors. They are all benign, round or oval. There are also one-sided and two-sided, single-chamber and multi-chamber. The size of tumors is no more than 20 - 100 mm. There are several varieties of this disease. A description follows.
A Baker's cyst is a compacted object. It can have a diameter from twenty to one hundred millimeters. Single chamber.
Ankylosing spondylitis cyst is one of the variants of the previous type. Rarely observed.
A meniscal cyst is a chamber filled with a liquid substance. There are two menisci inside the knee. In fact, these are just cartilages that act as gaskets, similar to a sickle. Their task is to cushion the joint. This is where this foreign reservoir appears.
Subchondral cyst - occurs mainly in older people. It does not reach a large value. Tumor 5 - 15 mm. Develops along with knee arthrosis.
Parameniscal cyst is almost the same as the previous one. The difference is that several cystic formations will appear after a meniscus tear has occurred. If it reaches large sizes, it will most likely aggravate the situation.
Ganglion cyst - originates from the innermost areas of the knee joint. Filled with liquid consistency. On palpation, a compacted elastic formation is felt. Rarely seen.
Synovial cyst - can develop if there is increased generation of synovial fluid. Appears in the synovial area and grows towards the popliteal fossa.
Prerequisites for the appearance
Before talking about the reasons, it should be noted that this disease develops in both children and adults. More often in boys than in girls.
The cause of a cyst in children may be immaturity of the body, insufficient development of the ligamentous apparatus, or problems with tissue stiffness. All these reasons are based on inflammation of the cavities of the knee joints.
Men and women also have enough prerequisites:
- fractures, dislocations of knees;
- large and prolonged forces to which the joints are exposed;
- meniscus injuries;
- arthritis resulting from inflammation;
- knee arthrosis
; - synovitis, bursitis in chronic form.
Symptoms
The difficulty of detection lies in the fact that at first the disease may not bother you. Often, signs (an unclear formation) are noticed by chance. There is usually no pain during movement or palpation.
The symptoms look somewhat different if it is parameniscus disease. Pain appears almost immediately when walking and bending or straightening the knee, but no external signs are observed for some time. And even a tumor is found only through examination.
The most vulnerable to the disease is the external meniscus - it is the most mobile. This is where the disease most often penetrates.
If the medial meniscus is affected, then if you bend the knee, swelling will appear in the front part of it. It disappears when unbent.
Survey
The traumatologist will accurately make a preliminary diagnosis after examination. But for successful treatment it is necessary to know exactly how the disease progresses inside the knee. For this purpose, a special examination is prescribed. Ultrasound, radiography. A minor incision is made in the muscle of the joint, an MRI and a puncture of the fluid are made. A set of these examinations will allow the doctor to correctly diagnose: the size of the formation, location, and other data.
Treatment options
Cystic diseases progress in different ways. In some cases it is acute, in most cases it is chronic. Therapy can also be performed in different ways. There are surgical and conservative options. They are listed below:
- Use of soft tissue or plaster casts;
- treatment using natural and physical factors;
- dissect the cyst and remove fluid from it (the use of hydrocortisone is not excluded);
- You can use folk remedies.
In fairness, it should be noted that surgical methods are preferable to conservative ones, since after using the latter, the possibility of relapses of this disease cannot be excluded. If the cyst is a by-product, it disappears on its own after treatment of the underlying disease.
The best treatment for meniscal cysts is arthroscopy.
Treatment among the people
It should be noted immediately and categorically that the best option to get help is to visit a doctor. If the disease is not advanced, you can, of course, use proven folk methods. But this is at the discretion of the patient himself. Here are some of such methods.
If it is determined that the cyst is caused by arthritis and arthrosis, you can use burdock leaves. Prepare until the last month of summer. Wash and grind using a meat grinder or blender. Squeeze out the juice and keep in a cool place. You need to drink it for thirty days. Dose - a teaspoon per day. It happens that one course is not enough. In this case, the course described above is repeated after a month.
You can use regular or blue clay. It needs to be prepared with a tincture of ordinary anti-inflammatory herbs: chamomile, calendula, sage. To prepare the decoction, use a tablespoon of herb per two hundred grams of clay. The resulting solution is applied to the knee.
Healthy joints to you!
Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr
Symptoms of a spinal cord tumor in adults
There are no typical or characteristic symptoms only for a tumor; all signs can mimic other diseases, especially in the early stages.
Therefore, you should consult a doctor to determine or rule out the problem with the following complaints. Pain syndrome. The most common manifestation of a tumor is pain that occurs in the area of the spine where the tumor began to grow. In the early stage, the pain may be mild or more severe, but there are no significant neurological symptoms. As the tumor progresses, disturbances in sensitivity and movement occur, the pain becomes stronger against the background of coughing or sudden movements, sneezing, physical activity, at night and when moving, tilting the head.
Movement disorders. Muscle weakness is also possible, which occurs in combination with sensitivity disorders, the phenomenon of muscle atrophy, sharp and sudden contractions, twitching of muscle groups that are relaxed.
Sensitivity disorders. Sometimes there is no pain, but superficial sensitivity may suffer, while maintaining a deep tactile sense. The patient may not feel pain, temperature, or touch, but perceives pressure and vibration.
Problems with the functioning of the sphincters. Possible disturbances in urinary functions and, less commonly, bowel movements. This leads to retention of urine or stool.
Also, as the process progresses, scoliosis of the spine may occur, which is formed due to pain, motor dysfunction or destruction of the vertebral bodies.
It is impossible to identify spinal cord tumors externally; they are located quite deep in the spinal canal.
A comment
The information presented in the article is fundamentally new; The work is well structured, illustrated and argued. In conclusion, we can once again clarify the details of the separate lesion of the cyst of the odontoid bone and the CII body, indicating the features of the embryogenesis of the cyst. These technical details will improve the perception of the article by the magazine's readers.
The article is undoubtedly of practical interest and can be recommended for publication in a specialized neurosurgical journal.
A.Yu. Mushkin
(Saint Petersburg)
A comment
The paper presents in detail two clinical cases of bone cysts in the clivus and axis.
Undoubtedly, the work is of scientific and practical interest, especially since the world literature does not describe such clinical observations of bone cysts localized in the area of the base of the skull and the craniovertebral joint.
These are rare, very interesting, from the point of view of clinicians, cases, which makes them very indicative. In addition, we were shown well-executed operations.
I consider it necessary to publish this work in the journal “Problems of Neurosurgery” as it is novel and contains information useful for colleagues.
A.O. Thickness
(Moscow)