The effectiveness of puncture therapy for sacral aneurysmal bone cysts in kids and teenagers. A concise overview of the available research. Presentation of clinical cases

BACKGROUND: Aneurysmal bone cysts (ABC) of the spine in children and adolescents are an urgent problem in modern traumatology–orthopedics, oncology and neurosurgery. Spinal ABC is recorded in 8–30% of all cases of ABC detected, while they account for up to 15% of all spinal tumors. The most rare area of ABC lesion is the sacral region, which accounts for less than 4% of reported cases. The treatment methods described in the literature can be divided into conservative, minimally invasive and surgical. The authors report on such methods as the introduction of adjuvant drugs into the cyst cavity, selective arterial embolization, etc. Some sources also mention the use of the drug denosumab. In the literature, you can find materials on surgical treatment in the form of open resection, bone grafting, cementing, as well as a combination of several techniques. CLINICAL CASES DESCRIPTION: Results of treatment aimed at reducing ABC activity, bone tissue repair, restoration of sacral support capacity, regression of neurological symptoms in its presence and pain syndrome. The material consisted of 8 patients (4 patients were described in a series of clinical cases) with a diagnosis of aneurysmal bone cyst of the sacrum, who were treated at the Department of Pediatric Bone Pathology and Adolescent Orthopedics of the Priorov National Medical Research Center of Traumatology and Orthopedics. A brief review of the literature is based on a search for articles in PubMed, Cyberlinenka, eLibrary, Google Scholar. The assessment of tumor changes at the treatment stages was carried out by measuring intracystal pressure using a Waldman device in mm of water. The program of the diagnostic arm “Gamma Multivox” (GC “Gammamed”, Russia) made it possible to evaluate the result of treatment according to CT data. The significance of changes in tumor parameters was assessed using the Wilcoxon landmark rank criterion for treatment stages involving at least 5 measurements. Statistical analysis was performed using the SciPy Stats package and Python programming language software. CONCLUSION: The result of the treatment was traced over a period of 1 to 8 years. Step-by-step puncture treatment reduces the activity of ABC, starts the process of bone tissue repair, restores the support capacity of the sacrum and reduces the volume of the tumor, promotes regression of pain and neurological symptoms due to the decompressive effect.