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Intraoperative navigation can aid in surgical treatment of symptomatic intraosseous pneumatocysts
Intraosseous pneumatocysts, benign air-containing lesions found in the spine and pelvis, have been observed in up to 10% of CT scans and are typically treated nonoperatively; however, symptomatic intraosseous pneumatocysts can effectively be treated using intraoperative CT-guided navigation and percutaneous injection of a calcium sulfate-calcium phosphate composite bone graft substitute, according to recently published study findings.
Because of greater pressure cycling and barotrauma encountered while underwater diving, all reported cases of symptomatic intraosseous pneumatocysts have presented in underwater divers, according to researchers.
The researchers presented a case of a 32-year-old active-duty male Navy dive instructor who had a 1-year history of increasing buttock pain with increased depth of diving. A CT scan showed he had an intraosseous pneumatocysts in the right posterior ilium.
Using CT-guided navigation, the diver was treated with a percutaneous injection of calcium sulfate-calcium phosphate composite bone graft substitute material. According to the researchers, this was the first description of such an operative treatment in the English literature.
The treatment provided the diver with complete relief of symptoms, and he was able to return to diving professionally. At 6-month follow-up, the patient had reached diving depths of 170 feet without pain.
The researchers concluded the use of intraoperative CT guidance resulted in accurate percutaneous localization, decompression and filling of the lesion with synthetic bone graft substitute. The procedure offered complete early relief of symptoms; however, similar results could be achieved using multiplanar fluoroscopy if a surgeon is not familiar with CT-guided navigation, according to the researchers. – by Robert Linnehan
Disclosure: The researchers report no relevant financial disclosures.