Determining the Best Treatment for Simple Bone Cyst: A Decision Analysis.
- Author:
Seung Yeol LEE
1
;
Chin Youb CHUNG
;
Kyoung Min LEE
;
Ki Hyuk SUNG
;
Sung Hun WON
;
In Ho CHOI
;
Tae Joon CHO
;
Won Joon YOO
;
Ji Hyun YEO
;
Moon Seok PARK
Author Information
- Publication Type:Original Article
- Keywords: Simple bone cyst; Unicameral bone cyst; Decision analysis; Autologous bone marrow injection
- MeSH: Analysis of Variance; Bone Cysts/*surgery; Bone Marrow Transplantation/*methods; Decision Trees; Humans; Practice Guidelines as Topic; Transplantation, Autologous
- From:Clinics in Orthopedic Surgery 2014;6(1):62-71
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND: The treatment of simple bone cysts (SBC) in children varies significantly among physicians. This study examined which procedure is better for the treatment of SBC, using a decision analysis based on current published evidence. METHODS: A decision tree focused on five treatment modalities of SBC (observation, steroid injection, autologous bone marrow injection, decompression, and curettage with bone graft) were created. Each treatment modality was further branched, according to the presence and severity of complications. The probabilities of all cases were obtained by literature review. A roll back tool was utilized to determine the most preferred treatment modality. One-way sensitivity analysis was performed to determine the threshold value of the treatment modalities. Two-way sensitivity analysis was utilized to examine the joint impact of changes in probabilities of two parameters. RESULTS: The decision model favored autologous bone marrow injection. The expected value of autologous bone marrow injection was 0.9445, while those of observation, steroid injection, decompression, and curettage and bone graft were 0.9318, 0.9400, 0.9395, and 0.9342, respectively. One-way sensitivity analysis showed that autologous bone marrow injection was better than that of decompression for the expected value when the rate of pathologic fracture, or positive symptoms of SBC after autologous bone marrow injection, was lower than 20.4%. CONCLUSIONS: In our study, autologous bone marrow injection was found to be the best choice of treatment of SBC. However, the results were sensitive to the rate of pathologic fracture after treatment of SBC. Physicians should consider the possibility of pathologic fracture when they determine a treatment method for SBC.
