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Moscinksi N, Sullivan PZ, Gokaslan ZL. Benign primary bone tumors, long-term management into adulthood. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2022.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Strohm JA, Strohm PC, Kühle J, Schmal H, Zwingmann J. Management of juvenile and aneurysmal bone cysts: a systematic literature review with meta-analysis. Eur J Trauma Emerg Surg 2023; 49:361-372. [PMID: 35989377 PMCID: PMC9925490 DOI: 10.1007/s00068-022-02077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/08/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Numerous approaches to the management of juvenile and aneurysmal bone cysts (ABC) are described in the specialist literature together with discussion of the associated healing and recurrence rates. Since there is currently no evidence-based treatment standard for these conditions, the aim of this systematic literature review with meta-analysis was to examine the different management approaches, evaluate the corresponding clinical outcomes and, as appropriate, to formulate a valid treatment recommendation. METHODS A systematic search on OVID Medline® based on a pre-existing search strategy returned 1333 publications. Having defined inclusion and exclusion criteria and analysis of the relevant full texts, 167 publications were included in the descriptive analysis and 163 in the meta-analysis. For this purpose, different subgroups were created, based on the type of cyst and the therapeutic procedure. Those subgroups were then analysed in relation to their healing rates, the number of recurrences and complication rates. RESULTS For aneurysmal bone cysts, both surgical removal and Doxycycline injection lead to excellent outcomes (98% healing) and low recurrence rates (6% and 11% resp.). Curettage (91% healing), including its combination with autologous cancellous bone graft (96% healing), showed very good healing rates but higher recurrence rates (22% and 15%, resp.), which were however improved by preoperative selective arterial embolization. A critical view must be taken of radiotherapy (90% healing) and the injection of alcohol (92% healing) because of their high complication rates (0.43/cyst and 0.42/cyst, resp.). In the management of juvenile bone cysts, surgical interventions like curettage and cancellous bone graft (87% healing) are far superior to non-surgical approaches (51% healing), furthermore, the application of autologous cancellous bone graft reduced the recurrence rate (3% recurrence) compared to curettage alone (20% recurrence). In subgroup analysis, treatment by ESIN was found to produce excellent outcomes (100% healing), though the patient collectives were small. CONCLUSION Surgical procedures to treat aneurysmal bone cysts appear to be the method of choice whereby Doxycycline injection may be an alternative. A surgical approach should be preferred in the treatment of juvenile bone cysts.
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Affiliation(s)
- Jonas A. Strohm
- grid.5963.9Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Peter C. Strohm
- grid.419802.60000 0001 0617 3250Clinic for Orthopedics and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany
| | - Jan Kühle
- grid.7708.80000 0000 9428 7911Department of Orthopedic and Trauma Surgery, University of Freiburg Medical Center, Freiburg, Germany
| | - Hagen Schmal
- grid.7708.80000 0000 9428 7911Department of Orthopedic and Trauma Surgery, University of Freiburg Medical Center, Freiburg, Germany
| | - Jörn Zwingmann
- Clinic of Orthopedic and Trauma Surgery, Oberschwabenklinik Ravensburg, Ravensburg, Germany
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Aljamaan YM, Alhathloul HS, Aleissa SI, Abaalkhail MS, Alhelal FH, Konbaz FM. Unusual presentation of aneurysmal bone cyst with scoliosis: a case report. J Med Case Rep 2022; 16:446. [PMID: 36443749 PMCID: PMC9706952 DOI: 10.1186/s13256-022-03685-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/20/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Aneurysmal bone cysts are benign bone tumors that not uncommonly involves the spine. However, this involvement can cause scoliosis, albeit rarely. This report focuses on the importance of proper management for complete tumor resection to prevent recurrence and spinal deformity. CASE PRESENTATION A 12-year-old Middle Eastern boy, with a history of T11 aneurysmal bone cyst resection and bone grafting carried out at another hospital, presented with spine deformity of 4 months' duration. The deformity was not associated with pain or neurological deficit. A whole-spine magnetic resonance imaging with contrast confirmed the recurrence of the aneurysmal bone cyst. Posterior spinal instrumentation with corpectomy of T11 was then performed, and confirmed with histopathology the recurrence of aneurysmal bone cyst. Two years post-corpectomy, deformity correction was done from T5-L4. CONCLUSION Management of aneurysmal bone cysts requires meticulous planning and full excision to prevent recurrence, especially in the growing spine. If neglected, it can cause major spinal deformities and cord compression, which places a medical burden on the patient and family. To avoid such complications, treating aneurysmal bone cysts along with scoliosis correction can prevent deformity progression.
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Affiliation(s)
- Yousef M Aljamaan
- Department of Orthopedic Surgery, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Hisham S Alhathloul
- Department of Orthopedics, Armed Forces Hospital, King Abdulaziz Air Base, Dhahran, Saudi Arabia
| | - Sami I Aleissa
- Department of Orthopedics, Ministry of The National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - Majid S Abaalkhail
- Department of Orthopedics, Ministry of The National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - Fahad H Alhelal
- Department of Orthopedics, Ministry of The National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - Faisal M Konbaz
- Spine Surgery Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Chan SK, Muhamad Ariffin MH. Aneurysmal Bone Cyst (ABC) of the C2 Vertebra. Cureus 2022; 14:e27735. [PMID: 36106253 PMCID: PMC9444833 DOI: 10.7759/cureus.27735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/30/2022] Open
Abstract
An aneurysmal bone cyst (ABC) is a benign bone lesion commonly found in the younger age group. The principal aim of complete surgical excision to prevent recurrence in an ABC of the C2 vertebra presents a surgical challenge. We report a case of a 13-year-old with an ABC of the C2 vertebra and the strategies in its management surgically and pharmacologically.
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Prabhu RM, Rathod TN, Vasavda A, Kolur SS, Tayade P. A rare case of an expansile spinopelvic aneurysmal bone cyst managed with embolization, excision, and fusion. Surg Neurol Int 2021; 12:580. [PMID: 34992897 PMCID: PMC8720427 DOI: 10.25259/sni_1045_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background: Aneurysmal bone cysts (ABC) are benign osteolytic lesions of the metaphyseal regions of long bones that typically contribute to rapid bony expansion. Here, we present an ABC involving the spinopelvic region in a 15-year-old male that required embolization, surgical excision, and fusion. Case Description: A 15-year-old male, presented with gradually progressive painful lower back swelling of 4 months’ duration. Once the diagnosis of an ABC was established based on a combination of X-ray, MR, and CT studies, he underwent selective arterial embolization, extended surgical excision (i.e. curettage), with a posterior fusion. Two years postoperatively, the patient remained neurologically intact without radiographic evidence of lesion recurrence. Conclusion: Large expansile ABC involving the vertebral bodies should be managed with preoperative selective arterial embolization, surgical decompression/curettage, and spinopelvic fixation.
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Affiliation(s)
- Rudra Mangesh Prabhu
- Department of Orthopaedics, Seth G.S Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Tushar N. Rathod
- Department of Orthopaedics, Seth G.S Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Akash Vasavda
- Department of Orthopaedics, Seth G.S Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Shivaprasad S. Kolur
- Department of Orthopaedics, Seth G.S Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Punit Tayade
- Department of Physiotherapy, MGM School of Physiotherapy, Mumbai, Maharashtra, India
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Validating the management paradigm for pediatric spinal aneurysmal bone cysts to optimize long-term outcomes: an institutional experience. Childs Nerv Syst 2020; 36:2775-2782. [PMID: 32130482 DOI: 10.1007/s00381-020-04553-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The optimal clinical management and outcomes of rare pediatric spinal aneurysmal bone cysts (spABC) is largely anecdotal. Current practice is based on bigger adult series, although given the disparities in spine growth of adults versus children, what impact this difference may have on long-term outcomes has yet to be substantiated. Correspondingly, the aim of this study was to describe the clinical course of all pediatric spABC cases managed at our institution to better understand this. METHODS A retrospective cohort study of all pediatric spABC cases presenting to our institution between 1993 and 2017 was performed using a predetermined set of selection criteria. Primary outcomes of interest were treatment modalities and their outcomes, recurrence status, and functional status. RESULTS A total of 24 pediatric spABC cases satisfied all criteria. Median age of diagnosis was 13.5 years, with 15 females and 9 males. Radicular pain was the presenting symptom in 21 (88%) cases. Diagnostic biopsy was pursued in 9 (38%) cases, pre-operative embolization in 8 (33%) cases, surgical intervention in 23 (96%) cases, and sclerotherapy in 2 (8%) cases. In terms of surgery, there were no intraoperative complications, and gross total resection (GTR) was achieved in 14 of the 23 (61%) cases. Overall, there were 5 (21%) cases which experienced recurrence by a median time of 8 months after initial surgery, all of which had initial subtotal resection. Median follow-up was 5 years, by which all patients demonstrated excellent functional status. CONCLUSIONS There are a number of feasible therapeutic modalities and combinations that can be utilized to maximize control of pediatric spABCs and optimize long-term function similar to that of adults, irrespective of developing versus developed spines. The incidence of recurrence is not negligible, and therefore, rigorous long-term surveillance is highly encouraged, particularly within the first post-operative year following mono-modal non-GTR treatment.
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Kumar BY, Thirumal R, Chander SG. Aneurysmal bone cyst of thoracic spine with neurological deficit and its recurrence treated with multimodal intervention - A case report. Surg Neurol Int 2020; 11:274. [PMID: 33033636 PMCID: PMC7538958 DOI: 10.25259/sni_466_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/15/2020] [Indexed: 01/25/2023] Open
Abstract
Background: Aneurysmal bone cysts (ABCs) are rare, representing about 1% of primary bone tumors, and 15% of all primary spine/sacral tumors. Notably, when they are located in poorly accessible regions such as the spine and pelvis, their management may be challenging. Treatment options include selective arterial embolization (SAE), curettage, en bloc excision with reconstruction, and radiotherapy. Case Description: A 16-year-old male presented with 2 months of mid back pain, left-sided thoracic radiculopathy, and left lower limb weakness (MRC – 3/5). MR imaging revealed an expansile, lytic lesion involving the T9 vertebral body, and the left-sided posterior elements resulting in cord compression. He underwent SAE followed by intralesional excision, bone grafting, and a cage – instrumented fusion. ABC was diagnosed from the biopsy sample. Postoperatively, the pain was reduced, and he was neurologically intact. Five months later, he presented with a new lesion that was treated with repeated SAE and three doses of zoledronic acid. At the end of 2 years, the subsequent, MRI and CT studies documented new bone formation in the lytic areas, with healing of lesion; additionally, he clinically demonstrated sustained pain relief. Conclusion: Here, we emphasized the importance of surgery for patients with ABC who develop focal neurological deficits. Treatment options should include SAE with bisphosphonate therapy for lesions that recur without neurological involvement.
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Affiliation(s)
- B Yogesh Kumar
- Department of Orthopaedics, Chettinad Hospital and Research Institute, Kanchipuram, Tamil Nadu, India
| | - R Thirumal
- Department of Orthopaedics, Chettinad Hospital and Research Institute, Kanchipuram, Tamil Nadu, India
| | - S G Chander
- Department of Orthopaedics, Chettinad Hospital and Research Institute, Kanchipuram, Tamil Nadu, India
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Sayago LR, Remondino RG, Tello CA, Piantoni L, Francheri Wilson IA, Galaretto E, Nöel MA. Aneurysmal Bone Cysts of the Spine in Children: A Review of 18 Cases. Global Spine J 2020; 10:875-880. [PMID: 32905733 PMCID: PMC7485085 DOI: 10.1177/2192568219881166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The aim of this study was to evaluate the clinical presentation, treatments, outcome, complications, and recurrence rate in the surgical and nonsurgical management of spinal aneurysmal bone cyst (ABC) in a series of 18 pediatric patients. METHODS Between 1988 and 2014, we evaluated 18 pediatric patients diagnosed with ABC confirmed by pathology studies. We analyzed clinical and radiological features, non-surgical and surgical treatment, outcome, and complications. RESULTS The series included 12 male and 6 female patients with a mean age of 10 years and 4 months, with a mean follow-up of 5 years. Location of the ABC was lumbar in 8, cervical in 7, thoracic in 2, and sacral in 1 case. Axial pain was the most common symptom followed by radicular involvement. Surgery was performed in the presence of spine instability or neurological involvement (tumor resection) and in the remaining, nonsurgical treatment (percutaneous intralesional injection of methylprednisolone and calcitonin). Recurrence was observed in 4 patients requiring reintervention. There were no procedure-related complications. CONCLUSION In patients without neurological involvement or spinal instability, nonsurgical treatment is the treatment of choice. Total or subtotal removal combined with posterior instrumented spinal fusion is recommended in cases with a neurological deficit. Both procedures have shown good long-term results.
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Affiliation(s)
- Luis R. Sayago
- Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | | | - Carlos A. Tello
- Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Lucas Piantoni
- Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina,Lucas Piantoni, Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, CABA, Buenos Aires, Argentina.
| | | | - Eduardo Galaretto
- Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Mariano A. Nöel
- Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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Abrar WA, Sarmast A, Sarabjit Singh AR, Khursheed N, Ali Z. Aneurysmal Bone Cysts of Spine: An Enigmatic Entity. Neurol India 2020; 68:843-849. [PMID: 32859826 DOI: 10.4103/0028-3886.293465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims The study was done to review the literature about the intriguing aspects of the aneurysmal bone cyst and to describe our experience with these cases. Design Retrospective. Material and Method We reviewed the records of all patients with primary spinal tumours whom we managed over last 8 years. We selected the patients with biopsy proven aneurysmal bone cyst (ABC) for our study. Results Four patients (two males and two females) were included. The age ranged from 15-18 years. Three of them had neurological deficits and one had only pain. All of them were operated and three required instrumentation for stabilization. Neurological deficits improved in all the cases. However we had to re- operate one of the cases for recurrence and that patient was administered adjuvant radiotherapy. Conclusions ABC is not a tumour in real sense but due to destructive nature that are classified as tumours. The patients have an excellent outcome as the disease is benign and has very low recurrence rates if surgical excision is complete. Best treatment modality is complete excision. Aneurysmal bone cyst is one of the uncommon tumors of the spine, and many of its features continue to be unclear even today. There is ambiguity about the definition, etiopathogenesis, radiological characteristics, histopathology and treatment modalities. They are common in young age and etiology is not clear. The presentation is varied with pain being the common symptom and neurological deficit depends on extent of cord involvement. The best treatment is controversial although surgery is believed to be curative in the majority of cases. We here describe our experience with four such cases who had varied clinical presentation and outcome.
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Affiliation(s)
- Wani Ahad Abrar
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Arif Sarmast
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Altaf Ramzan Sarabjit Singh
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Nayil Khursheed
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Zulfiqar Ali
- Department of Anesthesiology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Okuda A, Shigematsu H, Iwata E, Tanaka M, Morimoto Y, Masuda K, Ohbayashi C, Tanaka Y. An aneurysmal bone cyst at T1 treated with bone grafts containing calcitonin and methylprednisolone. J Orthop Surg (Hong Kong) 2020; 27:2309499019839626. [PMID: 30943849 DOI: 10.1177/2309499019839626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aneurysmal bone cysts (ABCs) rarely trigger pathological fractures. Various surgical and nonsurgical treatments have been reported for this condition. Herein, we present the examination findings and treatment for a 15-year-old girl who initially presented with adolescent idiopathic scoliosis and mild back pain, but subsequently experienced severe back pain. Magnetic resonance imaging revealed an ABC at T1, with an associated pathological fracture. We successfully treated the patient using posterior fixation with instrumentation, curettage, and bone grafts combined with calcitonin and methylprednisolone (mPSL). At 3 years post-surgery, there was no ABC recurrence and only mild back pain persisted. To our knowledge, this is the first report of open surgery (curettage and fixation) with local intralesional administration of calcitonin and mPSL for an ABC-induced pathological spinal fracture. We believe that this treatment is an effective option for ABCs associated with a pathological spinal fracture.
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Affiliation(s)
- Akinori Okuda
- 1 Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Hideki Shigematsu
- 1 Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Eiichiro Iwata
- 1 Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Masato Tanaka
- 1 Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Yasuhiko Morimoto
- 1 Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Keisuke Masuda
- 1 Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Chiho Ohbayashi
- 2 Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Yasuhito Tanaka
- 1 Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
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Nisson PL, Link TW, Carnevale J, Virk MS, Greenfield JP. Primary Aneurysmal Bone Cyst of the Thoracic Spine: A Pediatric Case Report. World Neurosurg 2019; 134:408-414. [PMID: 31678311 DOI: 10.1016/j.wneu.2019.10.151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND To date, only a few documented cases exist of complete or near-complete paraplegia of the lower extremities following collapse of a vertebral body secondary to an aneurysmal bone cyst. We describe the preceding symptoms associated with this catastrophic event along with surgical management and recovery. CASE DESCRIPTION A previously healthy, 13-year-old girl had experienced months of ongoing back pain with associated posture change. After collapsing at home in the bathroom, she was brought in by emergency medical services and presented to the neurosurgery service with an American Spinal Injury Association A spinal cord injury. Imaging revealed a collapsed T4 vertebral body including expanded and fluid-filled posterior elements and severe kyphotic spine angulation resulting in cord compression corresponding to her sensory and motor deficits. She underwent emergent surgery for spinal cord decompression with a T2-T4 laminectomy, transpedicular tumor resection, and T1-7 instrumented fusion. The patient tolerated the procedure well postoperatively. At 9 months after the event, she is ambulating independently without the use of crutches or a cane and has regained full strength for all muscle groups of her lower extremities. CONCLUSIONS The unique combination of back pain and posture change symptoms in an otherwise healthy pediatric patient should heighten clinical suspicion for a possible aneurysmal bone cyst of the spine when formulating a differential diagnosis. Additionally, despite the clinical severity at presentation, patients may still experience significant recovery following expeditious surgical intervention.
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Affiliation(s)
- Peyton L Nisson
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Neurological Surgery, Weill Cornell Medicine Brain and Spine Center, New York, New York, USA
| | - Thomas W Link
- Department of Neurological Surgery, Weill Cornell Medicine Brain and Spine Center, New York, New York, USA
| | - Joseph Carnevale
- Department of Neurological Surgery, Weill Cornell Medicine Brain and Spine Center, New York, New York, USA
| | - Michael S Virk
- Department of Neurological Surgery, Weill Cornell Medicine Brain and Spine Center, New York, New York, USA
| | - Jeffrey P Greenfield
- Department of Neurological Surgery, Weill Cornell Medicine Brain and Spine Center, New York, New York, USA.
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Abstract
RATIONALE Aneurysmal bone cyst (ABC) is a benign, reactive, non-neoplastic, proliferative, highly vascular osseous lesion. Because of the rarity of aggressive ABC cases, diagnostic and treatment protocols remain controversial and problematic. Treatment of ABC includes surgery, radiotherapy, selective arterial embolization (SAE), and a combination of these modalities. Successful outcomes have been reported, but the technical requirements and complications of each modality are quite different. We report the clinical, radiological, and therapeutic aspects of ABC of the thoracic spine in an adolescent who was treated by circumferential fusion, and we review the published literature. PATIENT CONCERNS An 18-year-old boy was transferred to our hospital complaining of a 2-month history of neck pain. DIAGNOSIS ABC of the thoracic spine INTERVENTIONS:: Six days after SAE, T1 corpectomy was performed via an anterior approach. We performed the operation using the posterior approach 1 week after the anterior approach. Histopathological examination confirmed the diagnosis of ABC. OUTCOMES No neurologic deterioration occurred during the postoperative period. Follow-up X-rays 2 year postoperative showed good bony fusion and alignment. LESSONS Primary ABC of the spine is a benign lesion with a potential to be locally aggressive and a high rate of local recurrence. The optimal treatment of thoracic lesions is challenging due to their proximity to the spinal cord and nerve roots, and their frequent association with deformity. Surgical resection/curettage, SAE, and radiotherapy can be used alone or in combination. Complete exposure and resection is crucial to avoid the recurrence. Circumferential fusion and reconstruction of stability are also important for the treatment of thoracic ABC, especially in adolescent patient.
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Raux S, Bouhamama A, Gaspar N, Brugières L, Entz-Werlé N, Mallet C, Dijoud F, Gouin F, Marec-Bérard P. Denosumab for treating aneurysmal bone cysts in children. Orthop Traumatol Surg Res 2019; 105:1181-1185. [PMID: 31358461 DOI: 10.1016/j.otsr.2019.04.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/27/2019] [Accepted: 04/11/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Aneurysmal bone cyst (ABC) is a benign tumour whose progression involves the RANK/RANKL signalling pathway. Surgery is the reference standard treatment but carries risks that vary with the site of the tumour. Denosumab is a human monoclonal IgG2 antibody that targets the RANK/RANKL pathway and may therefore hold promise for inhibiting ABC progression. The objective of this study was to evaluate denosumab use in paediatric patients (younger than 18 years) with ABC and to describe the clinical and radiological outcomes, as well as the side effect profile. HYPOTHESIS Denosumab is a viable option in children with ABC refractory to standard treatments. MATERIAL AND METHODS We retrospectively reviewed the medical files of paediatric patients given denosumab to treat ABC in any of 32 centres affiliated with the French Paediatric Cancer Society (Société Française du Cancer de l'Enfant, SFCE) and French Sarcoma Group (Groupe Sarcome Français, GSF-GETO). We identified 5 patients treated between March 2015 and June 2018. Median age was 8 years (range, 7-17 years). Pain was a symptom in all 5 patients and neurological deficits were present in 3 patients. Surgery was performed in 4 patients, either before (n=3) or after (n=1) denosumab therapy; the remaining patient had no surgery. Denosumab was given as monthly injections in a dosage of 70mg/m2 for a median of 12 months (range, 4-23 months). The clinical outcomes and changes in computed tomography and/or magnetic resonance imaging findings were evaluated. RESULTS Abnormalities in calcium and phosphate levels secondary to the ABC occurred in 2 patients. At median of 24 months (range, 0-28 months) after denosumab initiation, all 5 patients were free of pain, and the neurological deficits in 3 patients had improved. Central remineralisation and cortical reconstitution were demonstrated consistently by the imaging studies. DISCUSSION Denosumab is a viable treatment option in selected paediatric patients with inoperable ABC. The immediate adverse effect profile is acceptable. A larger study with a longer follow-up would be welcome to further assess the contribution of denosumab to the treatment of ABC. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sébastien Raux
- Département de chirurgie infantile, HFME, 59, boulevard Pinel, 69677 Bron, France.
| | | | | | | | - Natacha Entz-Werlé
- Hôpital Mère-Enfant Hautepierre, 1, avenue Molière, 67200 Strasbourg, France
| | - Cindy Mallet
- Hôpital universitaire Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - Frédérique Dijoud
- Département de chirurgie infantile, HFME, 59, boulevard Pinel, 69677 Bron, France
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14
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In Reply to “Some Alternative Treatments for Aneurysmal Bone Cysts”. World Neurosurg 2019; 127:660-661. [DOI: 10.1016/j.wneu.2019.03.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 11/19/2022]
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Heinrich C, Gospodarev V, Kheradpour A, Zuppan C, Douglas CC, Minasian T. Benign Giant Cell Lesion of C1 Lateral Mass: A Case Report and Literature Review. Brain Sci 2019; 9:brainsci9050105. [PMID: 31071908 PMCID: PMC6562483 DOI: 10.3390/brainsci9050105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 02/02/2023] Open
Abstract
Primary osseous tumors of the spinal column account for approximately 1% of the total number of spinal tumors found in the pediatric patient population. The authors present a case of a C1 benign giant cell lesion that was incidentally found in a 15-year-old patient. A transoral biopsy was performed followed by treatment with denosumab, with definitive management in the form of transoral tumor resection with subsequent occiput-cervical three posterior instrumented fusion. The patient tolerated all of the procedures well, as there were no post-operative complications, discharged home neurologically intact and was eager to return to school when assessed during a follow-up visit in clinic. Osteolytic lesions affecting the cervical spine are rare in the pediatric population. It is of utmost importance to have sufficient background knowledge in order to formulate a differential diagnosis, as well as an understanding of principles underlying surgical techniques required to prevent occipital-cervical instability in this patient population. The information presented will guide surgical decision-making by identifying the patient population that would benefit from neurosurgical interventions to stabilize the atlantoaxial junction, in the context of rare osteolytic conditions affecting the cervical spine.
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Affiliation(s)
| | - Vadim Gospodarev
- Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University, 11234 Anderson Street, Room 2567, Loma Linda, CA 92354, USA.
| | - Albert Kheradpour
- Department of Pediatric Hematology/Oncology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Craig Zuppan
- Department of Pathology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Clifford C Douglas
- Department of Neurosurgery, Loma Linda University Medical Center, 11234 Anderson Street, Room 2556, Loma Linda, CA 92354, USA.
| | - Tanya Minasian
- Department of Neurosurgery, Loma Linda University Medical Center, 11234 Anderson Street, Room 2556, Loma Linda, CA 92354, USA.
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Shkarubo AN, Kuleshov AA, Chernov IV, Vetrile MS, Berchenko GN, Lisyanskiy IN, Makarov SN. [Anterior stabilization of the CI-CIII vertebrae after transoral removal of an aggressive aneurysmal bone cyst of the CII vertebra (a case report and literature review)]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 82:111-118. [PMID: 30412164 DOI: 10.17116/neiro201882051111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Treatment of patients with atlantoaxial instability caused by various diseases of the skull base and craniovertebral junction combined with ventral compression of the brainstem is a complex issue that is ambiguously resolved in different ways. We present a case of stepped treatment, the most important component of which was successful transoral removal of an aggressive aneurysmal bone cyst of the CII vertebra with anterior CI-CIII segment stabilization using an individual system, which was performed through the same approach. CLINICAL CASE A 31-year-old male patient presented with destruction of the CII body and odontoid process affected by an aggressive aneurysmal bone cyst causing disintegration of the CII posterior wall and odontoid process, which clinically manifested by constricted motion and pain in the cervical spine. RESULTS Three-step surgical treatment was performed. First, we performed a puncture biopsy of the CII body through the submandibular approach as well as posterior occipitospondylodesis with metal instrumentation from the occipital bone level to the CIV vertebra. Two months later, the patient underwent transoral removal of the CII body and odontoid process lesion and anterior CI-CIII segment stabilization using an individual cover metal system through the same approach. Two weeks after the second intervention, the occipitospondylodesis was transformed to a posterior CI-CIII stabilization system. Control CT 8 months after surgery showed the correct position of both stabilization systems. CONCLUSION The use of individual instrumentation for anterior stabilization of the CI-CIII vertebrae in various diseases of the craniovertebral junction area is an effective and promising technique.
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Affiliation(s)
- A N Shkarubo
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A A Kuleshov
- Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia
| | - I V Chernov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - M S Vetrile
- Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia
| | - G N Berchenko
- Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia
| | - I N Lisyanskiy
- Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia
| | - S N Makarov
- Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia
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Symptomatic aneurysmal bone cysts of the spine: clinical features, surgical outcomes, and prognostic factors. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1537-1545. [PMID: 30838451 DOI: 10.1007/s00586-019-05920-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/30/2019] [Accepted: 02/12/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim of the study was to report the long-term outcomes and analyze the potential prognostic factors that may contribute to symptomatic patients with aneurysmal bone cyst (ABC) of the spine undergoing surgical treatments. METHODS A retrospective analysis of consecutive patients with ABCs of the spine was performed. The clinical features were reviewed, and the disease-free survival (DFS) and overall survival (OS) rates were estimated using the Kaplan-Meier method. Factors with p values ≤ 0.05 were subjected to multivariate analysis by Cox proportional hazards model to identify the independent prognostic contributors. p values < 0.05 were considered statistically significant. RESULTS A total of 42 patients with ABCs of the spine were included in the study. All patients received surgical treatments. The mean follow-up period was 41.3 months (median 39.5, range 24-64). Local recurrence was detected in eight patients after surgery in our center, whereas death occurred in three patients. The estimated 5-year DFS and OS rate was 54.1% and 76.8%, respectively. The statistical analyses indicated that both en bloc resection and primary/secondary tumor status were independent prognostic factors for DFS. CONCLUSIONS Secondary ABC status may be associated with worse prognosis, and en bloc resection remains the treatment of choice for ABCs with neurologic deficits or spinal instability of the spine, which is correlated with better prognosis for local tumor control. These slides can be retrieved under Electronic Supplementary Material.
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Kieser DC, Mazas S, Cawley DT, Fujishiro T, Tavolaro C, Boissiere L, Obeid I, Pointillart V, Vital JM, Gille O. Bisphosphonate therapy for spinal aneurysmal bone cysts. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:851-858. [DOI: 10.1007/s00586-018-5470-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/22/2017] [Accepted: 01/06/2018] [Indexed: 10/18/2022]
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Barbanti-Brodano G, Girolami M, Ghermandi R, Terzi S, Gasbarrini A, Bandiera S, Boriani S. Aneurysmal bone cyst of the spine treated by concentrated bone marrow: clinical cases and review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:158-166. [DOI: 10.1007/s00586-017-4978-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/11/2016] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
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Radiotherapy for aneurysmal bone cysts : A rare indication. Strahlenther Onkol 2016; 193:332-340. [PMID: 27957589 DOI: 10.1007/s00066-016-1085-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/09/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Aneurysmal bone cysts (ABC) are rapidly growing benign osseous lesions composed of blood-filled channels separated by fibrous septa. Since the value of external beam radiotherapy (EBRT) for ABC has not been well defined, the German Cooperative Group on Radiotherapy for Benign Diseases performed the national register study described herein. PATIENTS AND METHODS Five German institutions collected data regarding clinical features, treatment concepts, and outcome for patients with ABC who had been referred for local EBRT over the past 30 years. RESULTS Between 1990 and 2015, 10 patients with ABC were irradiated (5 female/5 male). Median age was 23 years (range 14-40 years). Involved sites were: spine (n = 3), sacrum/pelvis (n = 2), shoulder/scapula (n = 2), humerus (n = 1), femur (n = 1), and radius (n = 1). The median EBRT total and fractional doses were 28 Gy (range 5-40 Gy) and 2 Gy (range 1-2 Gy), respectively. Median follow-up was 65 months (range 12-358 months). Persistent pain relief was achieved for all patients. However, long-term follow-up response data were only available for 7/10 patients. All 7 patients exhibited a radiological response and experienced no recurrent disease activity or pain during follow-up. Acute and late radiogenic toxicities ≥ grade 3 and secondary malignancies were also not observed. CONCLUSION Primary or adjuvant EBRT seems to be an effective and safe treatment option for persistent or recurrent ABC. Fractionated doses below 30 Gy may be recommended.
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Ravindra VM, Eli IM, Schmidt MH, Brockmeyer DL. Primary osseous tumors of the pediatric spinal column: review of pathology and surgical decision making. Neurosurg Focus 2016; 41:E3. [DOI: 10.3171/2016.5.focus16155] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Spinal column tumors are rare in children and young adults, accounting for only 1% of all spine and spinal cord tumors combined. They often present diagnostic and therapeutic challenges. In this article, the authors review the current management of primary osseous tumors of the pediatric spinal column and highlight diagnosis, management, and surgical decision making.
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Affiliation(s)
- Vijay M. Ravindra
- 1Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah; and
| | - Ilyas M. Eli
- 1Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah; and
| | - Meic H. Schmidt
- 1Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah; and
| | - Douglas L. Brockmeyer
- 1Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah; and
- 2Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, Utah
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Rajasekaran S, Aiyer SN, Shetty AP, Kanna R, Maheswaran A. Aneurysmal bone cyst of C2 treated with novel anterior reconstruction and stabilization. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 28:270-278. [DOI: 10.1007/s00586-016-4518-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 11/30/2022]
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Spinal Intradural Aneurysmal Bone Cyst: A Case Report. World Neurosurg 2015; 84:593.e1-5. [PMID: 25769483 DOI: 10.1016/j.wneu.2015.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 02/14/2015] [Accepted: 02/17/2015] [Indexed: 11/21/2022]
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Aneurysmal bone cysts of the spine: treatment options and considerations. J Neurooncol 2014; 120:171-8. [PMID: 25059450 DOI: 10.1007/s11060-014-1540-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 07/05/2014] [Indexed: 10/25/2022]
Abstract
Aneurysmal bone cysts (ABCs) are benign bone lesions with annual incidences ranging from 1.4 to 3.2 cases per million people. Approximately, 10-30% of ABCs are found in the spine. Such lesions are traditionally treated with curettage or other intralesional techniques. Because ABCs can be locally aggressive, intralesional resection can be incomplete and result in recurrence. This has led to increased use of novel techniques, including selective arterial embolization (SAE). This study aims to: (1) compare outcomes based on extent of surgical resection, and (2) compare the efficacy of SAE versus surgical resection. Clinical data pertaining to 71 cases of spinal ABCs were ambispectively collected from nine institutions in Europe, North America, and Australia. Twenty-two spinal ABCs were treated with surgery, 32 received preoperative embolization and surgery, and 17 were treated with SAE. Most tumors were classified as Enneking stage 2 (n = 29, 41%) and stage 3 (n = 29, 41%). Local recurrence and survival were investigated and a significant difference was not observed between treatment groups. However, all three local recurrences occurred following surgical resection. Surgical resection was further categorized based on Enneking appropriateness. Recurrences only occurred following intralesional Enneking inappropriate (EI) resections (P = 0.10), a classification that characterized 47% of all surgical resections. Furthermore, 56% of intralesional resections were EI, compared to only 10% of en bloc resections (P = 0.01). Although SAE treatment did not result in any local recurrences, 35% involved more than five embolization procedures. Spinal ABCs can be effectively treated with intralesional resection, en bloc resection, or SAE. Preoperative embolization should be considered before intralesional resection to limit intraoperative bleeding. Treatment plans must be guided by lesion characteristics and clinical presentation.
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25
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Doss VT, Weaver J, Didier S, Arthur AS. Serial endovascular embolization as stand-alone treatment of a sacral aneurysmal bone cyst. J Neurosurg Spine 2014; 20:234-8. [DOI: 10.3171/2013.11.spine13412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aneurysmal bone cysts (ABCs) are destructive cystic lesions of the bone and are common in children. They are expansile in nature and, therefore, may become symptomatic. These have traditionally been treated surgically; but recently, endovascular embolization has shown promise as a stand-alone therapy. The authors describe a case of an ABC highlighting the effectiveness and efficiency of endovascular treatment. A 16-year-old boy was referred for a 4-month history of radiating back pain and urinary hesitancy. Findings from his neurological examination were normal, but he had problems ambulating because of pain. Magnetic resonance imaging and CT scanning showed a cystic mass in the sacrum; a biopsy was performed and diagnosis of ABC was confirmed. Treatment options were then discussed with the family.
The patient underwent 2 endovascular embolizations in approximately 1 month: Onyx 18 was involved in the first session, and N-butyl cyanoacrylate glue was used in the second session. After the first treatment, the patient experienced a dramatic decrease in pain and concomitant improvement in function. The patient went from being mildly symptomatic after the first treatment to completely asymptomatic after the second treatment. Clinical and radiographic follow-up obtained at 2, 6, and 18 months after initial treatment revealed the patient to be asymptomatic with progressive ossification.
Endovascular treatment can be effective in treating symptomatic cases of ABC in which surgery would carry significant risk. Selective arterial embolization can promote sclerosis and result in an immediate and significant decrease in pain.
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Affiliation(s)
- Vinodh T. Doss
- 1Departments of Neurology and
- 3Semmes-Murphey Clinic; and
| | - Jason Weaver
- 2Neurosurgery, University of Tennessee Health Science Center
- 3Semmes-Murphey Clinic; and
| | - Scott Didier
- 4Mid-South Imaging and Therapeutics, Memphis, Tennessee
| | - Adam S. Arthur
- 2Neurosurgery, University of Tennessee Health Science Center
- 3Semmes-Murphey Clinic; and
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Spontaneous regression after extensive recurrence of a pediatric cervical spine aneurysmal bone cyst. Case Rep Oncol Med 2014; 2014:291674. [PMID: 24707421 PMCID: PMC3970344 DOI: 10.1155/2014/291674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 12/11/2013] [Indexed: 11/17/2022] Open
Abstract
Aneurysmal bone cyst is a pseudotumoral lesion. Complete resection prior to selective arterial embolization seems to be the treatment of choice for the more extensive and destructive lesions. In these cases maintaining stability of the cervical spine is critical. This can be very challenging in children and adolescents in whom the axial skeleton is still growing. In this case a young girl presented with a voluminous cervical aneurysmal bone cyst encaging both vertebral arteries and spinal cord. The lesion was treated with aggressive surgical resection, followed by cervical vertebral fusion with instrumentation. After nine months the patient referred no pain and no neurological deficit. MRI scans showed an extensive local recurrence. The family of the young girl refused any other therapy and any other followup. The patients returned to our attention after five years with no pain and neurological deficit. Cervical spine radiographs and MRI scans showed a complete regression of the extensive local recurrence. In the literature, the possibility of spontaneous regression of residual part or local recurrence is reported. The case of this young girl provided the chance to attend a spontaneous regression in an extensive recurrence of aneurismal bone cyst.
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Guo J, Liang C. A giant aneurysmal bone cyst of the rib: Case report. Oncol Lett 2013; 7:267-269. [PMID: 24348861 PMCID: PMC3861589 DOI: 10.3892/ol.2013.1642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 10/18/2013] [Indexed: 12/05/2022] Open
Abstract
An aneurysmal bone cyst (ABC) is a benign tumor of the skeletal system, which most frequently occurs in long bones. An ABC arising from the rib is extremely rare and it is difficult to distinguish from other types of rib tumors. The present study describes an unusual case of a large ABC in the rib of a 17-year-old male. The entity is discussed with particular emphasis on the clinicopathological features, differential diagnosis and treatment. Due to difficulties in the pre-operative diagnosis, a possible diagnosis of ABC should be made aware when confronting an expansile rib mass. An en bloc resection of the mass and the affected portion of the rib is mandatory to obtain a satisfactory outcome.
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Affiliation(s)
- Juntang Guo
- Department of Thoracic Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Chaoyang Liang
- Department of Thoracic Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
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Kitamura T, Ikuta K, Senba H, Komiya N, Shidahara S. Long-term follow-up of a case of aneurysmal bone cyst in the lumbar spine. Spine J 2013; 13:e55-8. [PMID: 24017958 DOI: 10.1016/j.spinee.2013.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 10/30/2012] [Accepted: 06/01/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Aneurysmal bone cyst (ABC) in the spine is relatively rare, so little is known about the natural history of the disease. PURPOSE The purpose of this study was to describe a spinal ABC that was followed for an extended period from lesion enlargement to spontaneous regression. STUDY DESIGN Case report. METHODS A 63-year-old woman had a 1-year-long history of mild low back and bilateral leg pain without any significant neurologic deficits caused by lumbar spinal stenosis. At her first visit to our hospital, magnetic resonance imaging (MRI) showed a small cystic lesion on the left side of the L5 vertebral body. The patient's clinical symptom progression and MRI and computed tomography evaluations were reported for >13 years. RESULTS After 6 years, the cystic lesion enlarged significantly and extended into the left pedicle and transverse process of the L5 vertebra. The lesion was diagnosed as an ABC based on multilocular cysts with fluid-fluid levels on MRI and bony septations on computed tomography. Thirteen years after the first visit, the lesion regressed spontaneously without a clear reason, such as biopsy or fracture, and most of the lesion was replaced by fatty marrow. The patient's symptoms stabilized without neurologic deterioration during the follow-up period. CONCLUSIONS Although spinal ABC is an expandable cystic lesion, we should consider that such a lesion in an elderly patient could spontaneously regress.
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Affiliation(s)
- Takahiro Kitamura
- Department of Orthopaedic Surgery, Karatsu Red Cross Hospital, 1-5-1 Futago Karatsu, Saga 847-8588, Japan.
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Amendola L, Simonetti L, Simoes CE, Bandiera S, De Iure F, Boriani S. Aneurysmal bone cyst of the mobile spine: the therapeutic role of embolization. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22:533-41. [PMID: 23135793 DOI: 10.1007/s00586-012-2566-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 10/07/2012] [Accepted: 10/28/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Our aim is to define the role of embolization in the treatment of aneurysmal bone cyst of the spine in order to include this option in the decision making process. METHODS From April 2004 to November 2009, seven patients with primary aneurysmal bone cyst of the mobile spine treated by embolization have been prospectively followed-up. All clinical presentations and imagings were recorded. There are many options of embolic agent and techniques used, but all aim to devascularize the tumor. The therapeutic protocol includes: embolization repeated every 8 weeks until the appearance of radiographic signs of healing. Complications, rate of healing and clinical outcome were analyzed. RESULTS The number of embolizations varied from one to a maximum of seven without related intra- or post-operative complications. One patient, after four selective arterial embolizations, underwent direct percutaneous injection of embolic agents into the cyst. A clinical and radiographical response was achieved in all patients who were found alive and completely free of disease at mean follow-up of 46 months after last treatment and nobody crossed to surgical option. CONCLUSION Embolization seems to be the first option for spinal aneurysmal bone cyst treatment because of the best cost-to-benefit ratio. It is indicated in intact aneurysmal bone cyst, when diagnosis is certain, when technically feasible and safe and when no pathologic fracture or neurologic involvements are found. If embolization fails, other options for treatment would still be available.
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Affiliation(s)
- L Amendola
- Department of Orthopedics and Traumatology, Spine Surgery, Maggiore Hospital, 'C. A. Pizzardi', Largo Nigrisoli 1, 40100 Bologna, Italy.
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Treatment of an aneurysmal bone cyst of the lumbar spine in children and teenagers, about five cases. J Pediatr Orthop B 2012; 21:269-75. [PMID: 22158055 DOI: 10.1097/bpb.0b013e32834f16b5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The aneurysmal bone cyst is a rare tumor. Its treatment is complex when localized to the lumbar spine, with neurological, mechanical, and tumoral complications. The aim of this study is to describe these tumors, their treatment, and their long-term evolution, as well as to define an appropriate therapeutic strategy. Four of the five cysts had anterior and posterior extension. Three patients had neurological symptoms at diagnosis and two of them presented with pathological fracture. Surgical treatment was performed by intralesional resection. Long-term progress was always favorable, without recurrence or functional limitation. Two patients had a stable, mild spine deformity.
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Zenonos G, Jamil O, Governale LS, Jernigan S, Hedequist D, Proctor MR. Surgical treatment for primary spinal aneurysmal bone cysts: experience from Children's Hospital Boston. J Neurosurg Pediatr 2012; 9:305-15. [PMID: 22380960 DOI: 10.3171/2011.12.peds11253] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT 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. METHODS The medical records of all patients treated surgically for primary spinal ABCs between January 1998 and July 2010 were retrospectively reviewed. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Georgios Zenonos
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Novais EN, Rose PS, Yaszemski MJ, Sim FH. Aneurysmal bone cyst of the cervical spine in children. J Bone Joint Surg Am 2011; 93:1534-43. [PMID: 22204009 DOI: 10.2106/jbjs.j.01430] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Approximately 50% of patients with aneurysmal bone cyst of the spine are in the pediatric age group. Aneurysmal bone cyst is considered a locally aggressive benign tumor that may involve the posterior and anterior elements of the spine. Intralesional extended curettage and bone-grafting is the mainstay of treatment of aneurysmal bone cysts involving the long bones. However, the proximity to neurovascular structures and the potential remaining growth of the spine make its management in the spine more challenging. We evaluated the clinical presentation and the results of surgical treatment, following complete intralesional curettage along with spinal arthrodesis in pediatric patients with aneurysmal bone cysts of the cervical spine. METHODS We retrospectively reviewed the cases of seven children who were surgically treated for a primary aneurysmal bone cyst of the cervical spine between 1988 and 2008. There were four boys and three girls who had a mean age of 11.9 years (range, eight to 16.2 years) at the time of diagnosis. The mean duration of follow-up was 46.5 months (range, twenty-six to ninety-eight months). The mean age at the time of follow-up was sixteen years (range, 10.6 to 24.6 years). RESULTS Neck pain was the most common presenting symptom, and radiculopathy was the most common finding on physical examination. Radiographs, computed tomography, and magnetic resonance imaging were highly suggestive for the diagnosis that was confirmed histologically in all patients. The majority (four) of the patients required combined anterior and posterior approaches for complete removal of the tumor and arthrodesis of the spine. Two patients required additional procedures: one for a local recurrence and one for nonunion of the atlantooccipital junction. All patients were free of evidence of recurrent disease at the time of the last follow-up. With the exception of one patient who had permanent Horner syndrome, all patients were asymptomatic. CONCLUSIONS Preoperative arterial embolization, complete tumor excision by intralesional curettage and burring, followed by local spinal fusion, yield satisfactory results with a low rate of complications and low recurrence in children with an aneurysmal bone cyst of the cervical spine.
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Affiliation(s)
- Eduardo N Novais
- Department of Orthopaedic Surgery, University of Colorado, The Children's Hospital, 13123 East 16th Avenue, Aurora, CO 80045, USA
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Fay LY, Wu JC, Huang WC, Shih YH, Cheng H. One-stage posterior resection is feasible for a holovertebral aneurysmal bone cyst of the axis: a case report and literature review. ACTA ACUST UNITED AC 2009; 72 Suppl 2:S80-5. [PMID: 19944829 DOI: 10.1016/j.wneu.2009.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND For cervical spine ABC, staged surgery and the combination of both anterior and posterior approaches are usually necessary for lesions involving all 3 (anterior, middle, and posterior) columns of the spine (holovertebral). CASE DESCRIPTION A 20-year-old young man presented with quadriplegia and acute urine retention lasting for 3 days in November 2006. The diagnosis of an ABC involving the C2 vertebral body, pedicles, laminae, and spinous process was made by MRI. One-stage surgery with intralesional injection of fibrin glue via the posterior approach only was able to deliver complete resection and spinal stabilization. His neurologic function recovered well, and he was able to walk independently 10 days postoperation. At the 1-year follow-up, image studies of the cervical spine demonstrated good bone fusion without recurrence of ABC. The C2 vertebral body also showed resolution of ABC and good trabeculation. CONCLUSIONS Intralesional injection of fibrin glue during the operation for holovertebral ABC can be beneficial to (1) avoid using an anterior approach for complete resection and reconstruction, which was usually required in previous reports, and (2) effectively decrease the blood loss during surgery.
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Affiliation(s)
- Li-Yu Fay
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Aggressive "benign" primary spine neoplasms: osteoblastoma, aneurysmal bone cyst, and giant cell tumor. Spine (Phila Pa 1976) 2009; 34:S39-47. [PMID: 19829276 DOI: 10.1097/brs.0b013e3181ba0024] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Clinically based systematic review. OBJECTIVE To define optimal clinical care for primary spinal aggressive "benign" osseous neoplasms using a systematic review with expert opinion. METHODS Predefined focused questions on treatment of osteoblastomas, aneurysmal bone cysts and giant cell tumors were refined by a panel of spine oncology surgeons, medical and radiation oncologist. Keywords were searched through Medline and pertinent abstracts and articles obtained. The quality of literature was rated as high, moderate, low or very low. Based on literature review and expert opinion recommendations were composed through the GRADE system and rated as either strong or weak. RESULTS The literature searches revealed very low quality evidence with no prospective or randomized studies. There are a limited number of patients with aggressive primary osseous tumors. The osteoblastoma initial search identified 211 articles of which 17 were pertinent to the spinal questions. The aneurysmal bone cysts initial search revealed 482 articles initially of which 6 were pertinent; and the search on giant cell tumors identified 178 articles of which only 8 were focused on the predefined treatment questions. CONCLUSION Spinal aggressive benign osseous neoplasms have varying histology. Despite these differences surgical treatment should be directed at gross resection of the tumor, understanding that this may be limited by anatomic confines and the potential for morbidity.
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Wang VY, Deviren V, Ames CP. Reconstruction of C-1 lateral mass with titanium mesh cage after resection of an aneurysmal bone cyst of the atlas. J Neurosurg Spine 2009; 10:117-21. [PMID: 19278324 DOI: 10.3171/2008.10.spi08403] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aneurysmal bone cysts (ABCs) are rare benign tumors with a prevalence of 0.14 cases per 100,000 people. A majority of cases arise during adolescence, and there is a female predominance. This lesion accounts for 1.4% of all primary bone tumors. Aneurysmal bone cysts occur mainly in the long bones, with spinal involvement in 10-30% of cases. Cervical spine ABCs account for about one-third of spinal ABCs, and atlas involvement occurs in 1% of cases. Resection of ABCs at the atlas is difficult because of the location and the lack of proper instrumentation for reconstruction of C-1. The authors present a case of an ABC at C-1 in a child who underwent resection of the lesion and reconstruction of the lateral mass with a titanium mesh cage.
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Affiliation(s)
- Vincent Y Wang
- Department of Neurological Surgery, University of California, San Francisco, California, USA
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Application of a biphasic macroporous synthetic bone substitutes CERAFORM®: clinical and histological results. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2009. [DOI: 10.1007/s00590-009-0445-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Scoliosis is defined as a lateral deviation of the spine from the normal plumb line. Commonly, there is a rotational component and deviation also in the sagittal plane (kyphosis or hyperlordosis). When scoliosis presents in adults, it is often painful. In contrast, back pain in a child is considered rare, and serious underlying pathology should be excluded, particularly since idiopathic scoliosis is typically painless. A painful scoliosis in a child or adolescent, especially if the patient has a left-sided curve, should be examined thoroughly. The aim of this review is to illustrate the causes of a painful scoliosis in children, adolescents and adults.
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Abstract
In the treatment of primary tumors, complete local eradication is the main goal, as an oncologically appropriate surgical treatment can substantially improve the prognosis and even be considered a life-saving procedure. In deciding the best treatment for primary bone tumors of the spine, the choice of surgery, radiation therapy, chemotherapy, selective arterial embolization, or other medical treatments alone or in combination is based on diagnosis, staging, and a deep understanding of the biology and the behavior of each tumor. This article is a guide to diagnosing and treating such rare tumors.
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Pennekamp W, Peters S, Schinkel C, Kuhnen C, Nicolas V, Muhr G, Frangen TM. Aneurysmal bone cyst of the cervical spine (2008:7b). Eur Radiol 2008; 18:2356-60. [DOI: 10.1007/s00330-008-0944-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2007] [Revised: 01/14/2008] [Accepted: 02/07/2008] [Indexed: 11/24/2022]
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Frangen TM, Pennekamp W, Kuhnen C, Kiriyanthan G, Muhr G, Nicolas V, Schinkel C. [Aneurysmal bone cysts. First description of the extensive destruction of the upper cervical spine]. Unfallchirurg 2007; 110:640-4. [PMID: 17431575 DOI: 10.1007/s00113-007-1252-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Aneurysmal bone cysts are not counted among the classic malignant tumors, although they are destructive locally as blood filled reactive bone lesions. Typically, they are found in the metaphysis of the long bones, while localizations on the spine are rare. A 16-year-old female patient presented with unspecific, progressive neck pain which had been present for half a year. The initial x-ray showed no noticeable pathology whatsoever. Subsequently, the complete destruction of the first cervical vertebrae was found. The tumor had completely infiltrated and completely surrounded the spinal chord. A combined approach was used as therapy: resection of the dorsal tumor portion with occipitocervical spondylodesis (C0-C4) and postoperative radiation of the remaining ventral portions. Currently, the patient is free of complaints and recurrence. The differential diagnosis of an aneurysmal bone cyst should also be considered in cases of unspecific cervical vertebral complaints in adolescents that are not otherwise explainable.
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Affiliation(s)
- T M Frangen
- Chirurgische Klinik und Poliklinik, BG-Kliniken Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
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41
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Sansur CA, Pouratian N, Dumont AS, Schiff D, Shaffrey CI, Shaffrey ME. Part II: Spinal-cord neoplasms—primary tumours of the bony spine and adjacent soft tissues. Lancet Oncol 2007; 8:137-47. [PMID: 17267328 DOI: 10.1016/s1470-2045(07)70033-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Primary tumours of the bony spine and adjacent soft tissues most frequently present with pain although neurological deficits and spinal deformity can be present too. Knowledge of the spectrum of lesions that can affect the bony spine and the surrounding soft tissues is crucial in directing appropriate investigation and treatment. Patients need individualised approaches and treatment plans in view of the variations in tumour aggressiveness, spinal level, location within the vertebral body or posterior elements, involvement of soft tissues and structures surrounding the vertebral column, neurological deficits, and spinal instability.
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Affiliation(s)
- Charles A Sansur
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA 22908, USA
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Affiliation(s)
- John P Dormans
- Division of Orthopaedic Surgery, 2nd Floor, Wood Building, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA
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Codd PJ, Riesenburger RI, Klimo P, Slotkin JR, Smith ER. Vertebra plana due to an aneurysmal bone cyst of the lumbar spine. J Neurosurg Pediatr 2006; 105:490-5. [PMID: 17184084 DOI: 10.3171/ped.2006.105.6.490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aneurysmal bone cysts (ABCs) are benign, highly vascular osseous lesions characterized by cystic, blood-filled spaces surrounded by thin perimeters of expanded bone. Children and young adults are most often affected by spinal ABCs; more than 75% of patients are younger than 20 years old at presentation. Although ABCs have been documented in all areas of the axial and appendicular skeleton, ABCs of the spine present unique challenges due to the risk of vertebral destabilization, pathological fracture and vertebral body (VB) collapse, and neurological compromise. The authors describe the case of an 8-year-old child who presented with low-back pain and was subsequently found to have a lumbar ABC causing vertebra plana of the L-3 VB. They also review the literature on ABCs of the spine. This case highlights the importance of considering an ABC in the differential diagnosis when vertebra plana is seen in pediatric patients.
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Affiliation(s)
- Patrick J Codd
- Department of Neurosurgery, New England Medical Center, Tufts University, Boston, USA
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Khoury NJ, Hourani MH, Arabi MMS, Abi-Fakher F, Haddad MC. Imaging of Back Pain in Children and Adolescents. Curr Probl Diagn Radiol 2006; 35:224-44. [PMID: 17084238 DOI: 10.1067/j.cpradiol.2006.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To present the imaging findings of the wide spectrum of musculoskeletal diseases causing back pain in children and adolescents. DISCUSSION Back pain in children is a rare condition but may denote a serious health problem; hence, full clinical history, physical examination, and appropriate laboratory studies should be obtained. In this scientific exhibit, we present the imaging findings of the variable musculoskeletal diseases that are associated with back pain in children and adolescents. These disease processes include scoliosis of various causes; spondylolysis; spondylolisthesis; traumatic injuries; disc degeneration and herniation; Scheuermann's disease; spondylodiscitis; tumors (primary, secondary, hematogenous); and miscellaneous conditions (eg, metabolic disorders, sickle cell disease, osteoporosis). CONCLUSION A wide spectrum of diseases causing back pain in children is presented. Radiologists should be aware of the imaging findings of this rather uncommon entity to help in reaching the appropriate diagnosis.
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Affiliation(s)
- Nabil J Khoury
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
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45
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Abstract
The management of aneurysmal bone cyst depends on the age of the patient, the location, extent, aggressiveness and the size of the lesion. In the light of their experience and a review of the literature of 1256 aneurysmal bone cysts, the authors analyzed various treatment modalities. Inactive lesions can heal with biopsy or curettage alone. In active or aggressive lesions, elective treatment usually consists of curettage, whether associated or not with bone grafting and local adjuvants. Aneurysmal bone cyst in young children do not seem more aggressive than in older children. In pelvic locations, the emergence of a few cases of spontaneous healing (even in active or aggressive lesions) encourages the adoption of clinical and radiological supervision for some months after biopsy when possible. In some cases, the localization and extent of the cyst are such that operative treatment is extremely hazardous. Selective arterial embolization has made a considerable contribution towards the therapeutic solution of such cases. For some authors, direct percutaneous Ethibloc injection can be recommended as the first-choice treatment except in spinal lesions. Nevertheless, the complications encountered in some series after percutaneous embolization of aneurysmal bone cyst with Ethibloc should encourage the use of Ethibloc injection not as an initial treatment but as a reliable alternative to surgery.
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Affiliation(s)
- Jérôme Cottalorda
- Orthopaedics Pediatric Surgery Department, University of Medicine, Saint-Etienne, France.
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Khalil IM, Alaraj AM, Otrock ZK, Chamoun RB, Sabbagh AS, Skaf GS. Aneurysmal bone cyst of the cervical spine in a child: case report and review of the surgical role. ACTA ACUST UNITED AC 2006; 65:298-303; discussion 303. [PMID: 16488257 DOI: 10.1016/j.surneu.2005.06.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Accepted: 06/06/2005] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical treatment of aneurysmal bone cysts of the cervical spine, frequently affecting pediatric patients, is a challenge to operating surgeons. Complete tumor resection offers the best chance for cure. CASE DESCRIPTION We present the case of a child with an expansile aneurysmal bone cyst of the cervical spine that involves all 3 spinal columns. The advantages of combining a posterolateral followed by anterior approach after a preoperative angiography and vertebral artery balloon occlusion testing provided the added safety to maximize the extent of tumor resection. Spinal stabilization was successfully achieved in both approaches. CONCLUSION The challenge of surgically resecting aneurysmal bone cysts of the cervical spine in children enabled us to achieve a total resection with the help of preoperative angiography and vertebral artery balloon occlusion testing. Spinal instability should be addressed with reconstruction and stabilization techniques.
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Affiliation(s)
- Ismail M Khalil
- Division of Vascular Surgery, Department of Surgery, American University of Beirut Medical Center, PO Box 11-0236, Beirut 1107 2020, Lebanon
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Abstract
UNLABELLED The treatment of spinal tumors represents a challenge to spine care professionals. Fortunately, the incidence of new cases of primary malignant bone tumors is lower compared with that of other tumors. In the United States approximately 2000 malignant bone tumors of 7000 new sarcomas are diagnosed each year. Of these, 4% to 20% (80-400 tumors) of bone tumors are spinal tumors. Metastatic tumors are the most frequent tumor of bone and the most frequent tumor of the spinal column regardless of the origin of the primary tumor. More than 90% of spinal tumors are metastatic. Thirty to seventy percent of patients who die from cancer have evidence of vertebral metastases visible on careful postmortem examination, with the potential that this number could reach 85% in patients with breast cancer. Less than 10% of patients with spinal tumors present with spinal instability requiring surgical treatment; this accounts for approximately 18,000 new cases yearly. We will focus on the most recent advances in nonsurgical and surgical treatment of vertebral tumors. In surgical treatment, the evaluation and selection of patients, indications and surgical strategies, open and minimally invasive techniques, outcomes and complications will be discussed. LEVEL OF EVIDENCE Level V (expert opinion). See the Guidelines for Authors for a complete description of the levels of evidence.
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Affiliation(s)
- Edward D Simmons
- Department of Orthopaedic Surgery, State University of New York at Buffalo Buffalo, NY 14201, USA.
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Levin DA, Hensinger RN, Graziano GP. Aneurysmal Bone Cyst of the Second Cervical Vertebrae Causing Multilevel Upper Cervical Instability. ACTA ACUST UNITED AC 2006; 19:73-5. [PMID: 16462224 DOI: 10.1097/01.bsd.0000172073.38814.f9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Aneurysmal bone cyst (ABC) is a rare expansile osteolytic lesion of bone comprising proliferating vascular tissue lining blood-filled cystic cavities. ABCs occur most frequently in patients under age 20 and are uncommon after 30 years of age. Three to 20% of cases occur in the spine, and upper cervical involvement is rare. Lesions may grow rapidly and attain considerable size. When involving the spine, ABCs may result in instability and neurologic compromise, making prompt diagnosis and treatment imperative. We present a report of a 6-year-old child with an ABC of the second cervical vertebrae causing atlantoaxial and C2-C3 instability, treated successfully with curettage, decompression, and anterior and posterior arthrodesis with posterior instrumentation. METHODS The patient underwent a staged procedure consisting of posterior instrumentation from occiput to C4 and curettage of the lesion followed by anterior cervical discectomy and fusion of C2-C4. The diagnosis, surgical treatment, and outcome of the case are described and relevant literature reviewed. RESULTS The patient sustained no lasting neurologic deficits and was disease-free at 3 years of follow-up. CONCLUSIONS ABC is a rare but potentially devastating cause of upper cervical spine instability. Prompt detection and treatment with curettage, decompression, and fusion can produce a satisfactory result and prevent spinal cord injury.
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Affiliation(s)
- David A Levin
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.
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Soyer T, Karnak I, Talim B, Tanyel FC. Aneurysmal Bone Cyst of the Rib in a Child: Report of a Case. Surg Today 2005; 35:886-9. [PMID: 16175473 DOI: 10.1007/s00595-005-3020-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2004] [Accepted: 11/16/2004] [Indexed: 11/30/2022]
Abstract
An aneurysmal bone cyst (ABC) is a benign tumor of the skeletal system, which is rare in childhood and mostly occurs in long bones. An aneurysmal bone cyst of the rib is also very rare and it is difficult to distinguish from other rib tumors of childhood, especially Ewing's sarcoma. An unusual case of an aneurysmal bone cyst in the rib of a 12-year-old boy is presented herein. The entity is discussed with special emphasis on the clinicopathologic features, differential diagnosis, and treatment. The most important diagnostic aid in accurately identifying such cysts is to be aware of such a possible diagnosis when a child presents with a rib mass. An en bloc resection of the mass along with the affected portion of the rib is mandatory to obtain a satisfactory outcome.
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Affiliation(s)
- Tutku Soyer
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, 06100, Turkey
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Garg S, Mehta S, Dormans JP. Modern surgical treatment of primary aneurysmal bone cyst of the spine in children and adolescents. J Pediatr Orthop 2005; 25:387-92. [PMID: 15832161 DOI: 10.1097/01.bpo.0000152910.16045.ee] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Aneurysmal bone cyst (ABC) is a benign but locally aggressive tumor-like condition. Treating children with spinal involvement poses special hazards due to the proximity of the lesion to the spinal cord and the need to preserve spinal stability and balance after surgery. Twelve children with ABC treated between 1990 and 2002 at a tertiary pediatric musculoskeletal tumor center using modern surgical techniques and technology were retrospectively reviewed. A surgical technique using a four-step approach of intralesional curettage, high-speed bur, electrocautery, and bone grafting was found to have a significantly reduced rate of recurrence (0/8 cases) compared with traditional intralesional curettage and bone grafting (4/4 cases) (P < 0.002). Short-segment spinal fusion with instrumentation was also done in five cases immediately after excision of the ABC under the same anesthesia and was a nonsignificant marker for reduced rate of recurrence (P < 0.08), likely secondary to wide exposure. Overall, at last follow-up, all 12 patients were alive and well with no evidence of disease and no significant spinal deformity. The four-step approach to treatment of ABC of the spine with appropriate spinal instrumentation and fusion is recommended for successful treatment of this aggressive lesion.
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Affiliation(s)
- Sumeet Garg
- Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA
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