Cervical Spine Aneurysmal Bone Cysts in the Pediatric Population: A Systematic Review of the Literature

Abstract

Cervical spine aneurysmal bone cysts (ABCs) in pediatric patients have not been thoroughly studied. Using PubMed and Google Scholar, a systematic review of the literature was conducted for publications that included patients aged ≤15 years with a confirmed diagnosis of ABC in the cervical spine. Thirty-five studies with a total of 71 patients met the inclusion criteria. Nearly 80% of patients presented with neck or shoulder pain. The axis was the level most frequently involved (34.28%), followed by C5 (24.28%). Posterior elements were most likely to be affected (88.46%) while exclusive involvement of the body was uncommon. To our knowledge, this is the first systematic review of the literature regarding ABCs of the cervical spine in a pediatric population. Spinal ABCs are rarely found in the cervical region, and their treatment remains challenging due to their location, vascularization, and a high overall recurrence rate even with surgical resection.

Pediatric Cervical Aneurysmal Bone Cyst Treated by Endovascular Approach

“…ABC may arise from any bone; however, the metaphysis of long bones is the most frequently affected site [5]. Although the cervical region is rarely involved, the presentation of our patient is typical for these cases: in a recent meta-analysis with 71 patients presenting with cervical spine ABC, Protas et al [6] found complaints of neck or shoulder pain in ∼80% of the patients; moreover, posterior elements were involved in 88%, and C2 was the most frequently affected level (34%). In the cervical spine, CT scan usually shows lytic lesions described as honeycomb or an eggshell ballooning of the bone cortex, while MR imaging shows a characteristic fluid-fluid interface on T2W and a heterogeneous appearance on T1W [7].…”

Aneurysmal bone cyst in the cervical spine

“…ABCs are rare but benign, highly vascular tumours and account for up to 1% of all bone tumours and 15% of primary spinal tumours 1–4. The majority of ABCs occur in the first two decades of life1–4 and uncommonly affect the cervical spine, with only 71 cases reported in the literature till recently 1…”

“…Fluid-fluid levels, in particular, are strongly suggestive of an ABC 10. However, a plethora of other diseases including giant cell tumour, eosinophilic granuloma, fibrous dysplasia, unicameral bone cyst, chondroblastoma, chondrosarcoma, chondromyxoid fibroma, Ewing’s tumour and metastatic carcinoma have all been reported to display similar imaging features as an ABC 1 4 5. A combination of both radiographs and MRI, alongside histological examination, is required to increase the likelihood of an accurate diagnosis 5…”

“…Although complete surgical excision of ABCs has been associated with high rates of cure,11 12 recurrence, however, remains a concern even after complete excision 1–4 7 8 11 13. The risks of aggressive surgery include spinal instability which may necessitate spinal instrumentation and fusion 2 3.…”

“…The risks of aggressive surgery include spinal instability which may necessitate spinal instrumentation and fusion 2 3. Perioperative embolisation to aid vascular control has also been used as adjuvant therapy 1 11. Less aggressive surgical options include curettage14 while sclerotherapy is also reported to be safe and effective 11…”