Determining the best treatment for simple bone cyst: a decision analysis

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Decision Analysis in Medicine

Background:

• Treatment for simple bone cysts (SBC) in pediatric patients lacks a standardized approach.
• Physician preference significantly influences the choice of SBC treatment modalities.
• Evidence-based analysis is needed to guide optimal SBC management.

Purpose of the Study:

• To compare the efficacy of five different treatment options for simple bone cysts in children.
• To identify the most advantageous treatment strategy for SBC using decision analysis.
• To provide evidence-based recommendations for SBC treatment in pediatric patients.

Main Methods:

• A decision tree model was constructed, encompassing five SBC treatments: observation, steroid injection, autologous bone marrow injection, decompression, and curettage with bone graft.
• Probabilities for various outcomes and complications were derived from a comprehensive literature review.
• Rollback analysis and sensitivity analyses (one-way and two-way) were employed to determine the optimal treatment and assess result robustness.

Main Results:

• Autologous bone marrow injection demonstrated the highest expected value (0.9445), outperforming observation (0.9318), steroid injection (0.9400), decompression (0.9395), and curettage with bone graft (0.9342).
• Sensitivity analysis indicated that autologous bone marrow injection remained superior to decompression when the risk of pathologic fracture or persistent symptoms was below 20.4%.

Conclusions:

• Autologous bone marrow injection emerges as the leading treatment option for simple bone cysts based on this decision analysis.
• The efficacy of autologous bone marrow injection is contingent on the post-treatment rate of pathologic fractures.
• Clinical decision-making for SBC should incorporate the potential risk of pathologic fractures.