Simple bone cyst of the axis

Simple bone cyst of spinal vertebrae: two case reports and literature review

Simple bone cyst (SBC) is not a common lesion in the spine and especially in the vertebral body. We intend to report two cases of SBC located in the vertebral body, and review the literature. Two cases include a 24 year-old male and 26 year-old male with vertebral body lesion of T12 and L5 vertebrae,retrospectively. Both lesions were found to be SBC and confirmed by pathology. Both cases were managed with surgery, the cavity was filled with bone graft and posterior spinal fusion and instrumentation with pedicle screws, and rods were carried out. There was no recurrence. There have been 21 cases of SBCs in English literature, and only 8 cases have been reported in the vertebral body. SBC is a rare benign lesion in the spine and it should be considered in the differential diagnosis when suggested by radiologic investigations.

Surgical treatment of clival and axis bone cysts

OBJECTIVE

The study objective is to present the tactics of surgical treatment of simple (solitary) bone cysts of the clival region and CII body.

MATERIAL AND METHODS

Two patients were operated on for simple clival and axis cysts.

RESULTS

The first patient with a simple clival cyst underwent transoral clivectomy and bone cyst evacuation. Postoperative control SCT scans revealed that the cyst cavity was lined with a hemostatic material and biological glue. Restoration of bone structures of the clivus occurred after 8 months. The second patient with a simple cyst of the second cervical vertebra (axis) underwent a two-stage surgical treatment: occipitospondylodesis was carried out first, and transoral removal of the pathological process of the CII body was performed at the second stage. Control scans a year after the surgery revealed the formation of bone tissue in the axis body region, an increased cystic cavity in the odontoid process of the axis, and posterior migration of the odontoid process, which caused compression of the brainstem structures. In connection with this, we performed transoral re-intervention with removal of the cystic separated odontoid process. Postoperative control scans revealed complete removal of the cystic odontoid process and decompression of the dural sac. The article provides a detailed analysis of the modern literature that has not reported any cases of a simple bone cyst located in the clivus or upper cervical vertebrae region and, thus, has not described the tactics for surgical treatment of these complex diseases. The article presents illustrative pre-, intra-, and postoperative images and histological specimens.

CONCLUSION

The described cases present successful recurrence-free surgical treatment of simple (solitary) bone cysts located both in the clivus region (1 case) and in the body and odontoid process of the axis (1 case). A feature of the second case was that the patient had an extremely rare combination of a bone cyst of the C2 body and the cystic separated odontoid process of the axis (cystic os odontoideum).

Treatment of unicameral bone cyst: systematic review and meta analysis

PURPOSE

Different treatment modalities have been utilized to treat unicameral bone cyst (UBC), but evidence has not been fully described to support one treatment over another and the optimal treatment is controversial. The aim of this quantitative systematic review was to assess the effectiveness of different UBC treatment modalities.

METHODS

We utilized Pubmed to isolate retrospective studies on patients with UBC who received any kind of treatment. The included studies needed to have a minimum sample size of 15 patients, and have provided data on radiographic healing outcome.

RESULTS

Sixty-two articles were selected for the meta-analysis from a total of 463 articles. The cumulative sample size was 3,211 patients with 3,217 UBC, and male to female ratio was 2.2:1. The summary or pool estimate of methylprednisolone acetate (MPA) injection resulted in a healing rate of (77.4 %) that was comparable to bone marrow injection (77.9 %). A higher healing rate was observed with MPA injection when inner wall disruption was performed. The pool estimate of bone marrow with demineralized bone matrix injection was high (98.7 %). UBC healing rate after surgical curettage was comparable whether autograft or allograft was utilized (90 %). UBC treatment with flexible intramedullary nails without curettage provided almost 100% healing rate, while continuous decompression with cannulated screws provided 89 % healing rate. Conservative treatment indicated a healing rate of 64.2, 95 % CI (26.7-101.8).

CONCLUSIONS

Active treatment for UBC provided variable healing rates and the outcomes were favorable relative to conservative treatment. Due to the heterogeneity of the studies and reporting bias, the interpretation of these findings should be handled with caution.

CSF bone cyst in a cervical vertebra

A 43 year male patient presented with neck pain, upper limb paraesthesia and right foot weakness. A MRI scan revealed a bone cyst involving C4 spinous process, lamina, pedicles and the posterior part of the vertebral body causing focal spinal stenosis. A C4 laminectomy and C3-C5 lateral mass screw fixation was done. Intra-operatively the cyst was found to contain CSF with an associated dural defect. A CSF cervical vertebral cyst has not been previously reported in the literature. The clinical presentation, radiological features and management of this CSF vertebral cyst is discussed.

A simple bone cyst located in the pedicle of the lumbar vertebra

A simple bone cyst located in the spine is rare. In the current work, we have documented the first case of a simple bone cyst located in the pedicle of the lumbar vertebra. The patient was a 50-year-old woman with low back pain. Radiographs of the lumbar region of the spine showed a well circumscribed radiolucent lesion with surrounding bone sclerosis in the right pedicle of L3. Computed tomography (CT) showed that the right pedicle was completely occupied by the cyst and slightly expanded. The cystic lesion extended to both the vertebral body and the lamina. T1-weighted magnetic resonance imaging (MRI) showed uniform low intensity, and T2-weighted MRI showed uniform very high intensity. Signal enhancement by gadolinium diethylenetriaminepenta-acetic acid was not observed in the lesion. During the operation, the cavity of the cyst was filled with 2 mL of serosanguinous fluid. Subsequent histologic examination showed a thin layer of connective tissue in the inner surface of the cyst.

Simple bone cyst with pathologic lumbar pedicle fracture: a case report

STUDY DESIGN

A case report and review of the literature are presented.

OBJECTIVE

To describe an unusual simple bone cyst involving the pedicle of lumbar spine.

SUMMARY OF BACKGROUND DATA

To the authors' knowledge, only nine cases of a simple bone cyst involving the spine have been reported. Most of these reports have described mild back or neck pain because the presenting symptoms or cysts were found incidentally. In the reported case, acute severe back pain with radiating pain developed. Therefore, the study focus was on the unusual location, the presenting symptoms, and its spinal involvement.

METHODS

A cystic lesion involving the left pedicle of the first lumber vertebra was identified in a 53-year-old woman with sudden-onset severe back pain with pain radiating to the left leg. Surgical resection was undertaken along with review of the patient's medical record, imaging studies, microscopic findings of the lesion, and the related literature.

RESULTS

Microscopic examination of the cystic lesion corresponded with the findings of a simple bone cyst. A thin fibrous membrane with reactive bone formation was identified without evidence of hemorrhage. A favorable result was achieved by surgical resection.

CONCLUSIONS

This case study suggests that a simple bone cyst may be found in any portion of the spine, including the pedicle. Severe resting pain would be elicited by a pathologic fracture of the pedicle. Direct nerve compression by the fractured fragment and chemical irritation by cystic fluid would be compatible with the observed clinical manifestations.

Simple bone cyst of lamina of lumbar spine: a case report

STUDY DESIGN

A case report and literature review.

OBJECTIVE

To describe an extremely rare simple bone cyst involving the lamina of the lumbar spine.

SUMMARY OF BACKGROUND DATA

Simple bone cysts involving the spine are very rare. Moreover, the authors are unaware of any published report of a simple bone cyst involving the lamina of the spine.

METHODS

A cystic lesion, incidentally identified in a patient with lumbar disc herniation of L5-S1, located at the left lamina of L5, was surgically treated with complete resection of the involved lamina and discectomy of L5-S1. Medical records, imaging studies, histologic findings, and related literature are reviewed in this study.

RESULTS

Histologic examination of a section of the cystic lesion showed a thin fibrous lining membrane of the cyst surrounded by well-vascularized new bone formation. This result is consistent with the findings of previously reported simple bone cysts in other sites of the body, including the spine.

CONCLUSION

This study suggests that a simple bone cyst may be included in the differential diagnosis of a cystic lesion of the posterior elements, especially laminae, of the spine.