Surgical treatment for primary spinal aneurysmal bone cysts: experience from Children's Hospital Boston

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Spinal aneurysmal bone cysts (ABCs) constitute a rare and clinically challenging disease, primarily affecting the pediatric population. Information regarding the management of spinal ABCs remains sparse. In this study the authors review their experience with spinal ABCs at Children's Hospital Boston.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The medical records of all patients treated surgically for primary spinal ABCs between January 1998 and July 2010 were retrospectively reviewed.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Fourteen cases were identified (6 males and 8 females, ages 5–19 years old). The ABCs were located throughout the spine, with an equal number in the thoracic and lumbar spine, and rarely in the cervical spine. The majority of patients presented with back pain, but neurological deficits and spinal deformity were common. A variety of radiographic techniques were used to establish the diagnosis, including needle biopsy. Preoperative selective arterial embolization was performed in 7 cases (50%), and the majority of cases required spinal instrumentation along with resection. Mean follow-up was 55.9 months (range 15–154 months) after initial intervention. Two ABCs recurred (14%), at 9 months and 8 years after incomplete initial resection, and the patients underwent reoperation. Complete resection was ultimately achieved in all cases. All patients were asymptomatic and neurologically intact at their last follow-up evaluation, and showed no evidence of deformity or recurrence on imaging.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Computed tomography and MR imaging are adequate for an initial evaluation of spinal ABCs, although solid variants can present a diagnostic challenge. Given the high rates of recurrence with residual disease, complete obliteration of the lesion should be the goal of treatment. Preoperative embolization is often performed, although in the authors' opinion the degree of bleeding tends not to support its routine use. Long-term follow-up is warranted as recurrences can occur years after initial intervention. However, gross-total excision in conjunction with spinal stabilization, as needed, usually provides cure of the ABC and excellent long-term spinal alignment.</jats:p></jats:sec>

Percutaneous Doxycycline Treatment of Aneurysmal Bone Cysts With Low Recurrence Rate: A Preliminary Report

“…We found all patients had a reduction in the size of the area of lytic destruction if not complete resolution of lytic foci (in two patients). This consistent response compares favorably with treatments including en bloc resection and amputation [35,42,44]. Furthermore, the lack of need for posttreatment physical rehabilitation (once pathologic fractures heal) offers patients greater mobility and maintenance of normal activities of daily living (recreational and work activity within limits set by the patient's orthopaedic surgeon) during the therapeutic regimen.…”

“…The 5% recurrence rate demonstrated in this series, particularly with juxtaphyseal lesions, provides an acceptable comparative recurrence rate [1,11,16,17,25,28,33,35,36,42,44] with which to pursue further study of this percutaneous treatment option. Furthermore, when recurrence (evidence of residual foci of tumor cells) occurs, patients are able to pursue a minimally invasive option of percutaneous treatment of small recurrent foci.…”

“…In addition, evidence of new bone healing provides key information for the physicians involved that treatment was progressing in the proper direction. Evidence of healing in 100% of patients compares favorably with surgical and nonsurgical care series [1,11,16,17,25,28,33,35,36,42,44].…”

“…The recurrence rate of ABCs after traditional surgical treatments ranges from 12% to 71% (71% in children \ 10 years) with 90% detected within 2 years of surgical treatment [11,16,17,25,28,35,42,44]. Recurrence is particularly associated with juxtaphyseal locations of ABCs in skeletally immature patients [16].…”

Cervical Spine Aneurysmal Bone Cysts: A Meta-Analysis of 114 Cases and Comparison of Clinical Features between Pediatric and Adult Patients

“…Radicular pain presented significantly more in pediatric patients than adults. CT imaging will typically show a lytic lesion with ballooning of the cortex, described as an eggshell or honeycomb, which is characteristic of ABC of the cervical spine (Boriani et al, 2001;; Zenonos et al, 2012). T2-weighted MRI is used to rule out any differential diagnosis such as fibrous dysplasia, telangiectatic osteosarcoma, chondroblastoma, osteoblastoma or giant cell tumors, and to facilitate a definitive diagnosis that can only be confirmed by histological analysis (Liu et al, 2003;; Caro et al, 1991;; Boriani et al, 2001).…”