Surgical management of pediatric spinal aneurysmal bone cysts: patient series

Benjamin E Flyer Division of Neurosurgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina; and

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Erik B Vanstrum Department of UCLA Head & Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, California

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Nicholas Chapman Division of Neurosurgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California

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Joseph H Ha Division of Neurosurgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California

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Jacob K Al-Husseini Division of Neurosurgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California

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Jason K Chu Division of Neurosurgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California

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J. Gordon McComb Division of Neurosurgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California

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Susan R Durham Division of Neurosurgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California

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Mark D Krieger Division of Neurosurgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
Department of Surgery, Children’s Hospital Los Angeles, Keck School of Medicine of USC, University of Southern California, Los Angeles, California

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Peter A Chiarelli Division of Neurosurgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California

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BACKGROUND

Aneurysmal bone cysts (ABCs) are rare, highly vascular osteolytic bone lesions that predominantly affect pediatric populations. This report evaluates the clinicopathological data of pediatric patients with spinal ABCs. The medical records for all patients at Children’s Hospital Los Angeles with biopsy-proven ABCs of the spine between 1998 and 2018 were evaluated.

OBSERVATIONS

Seventeen patients, 6 males and 11 females, were identified. The mean age at surgery was 10.4 years (range, 3.5–20 years). The most common presenting complaint was pain at the lesion site 16/17 (94%), followed by lower-extremity weakness 8/17 (47%). Resection and intralesional curettage were performed in all patients. Three (18%) of 17 patients underwent selective arterial embolization prior to resection. Spinal stability was compromised in 15 of 17 patients (88%), requiring instrumented fusion. Five (29%) of the 17 patients received additional therapy including radiation, calcitonin-methylprednisolone, or phenol. Four (23.5%) of 17 patients experienced a recurrence, and the mean time to recurrence was 15 months. The postoperative follow-up ranged from 6 to 108 months (median, 28 months). Reoperation occurred after an average of 35 months. At the recent follow-up, patients were free of disease.

LESSONS

Gross-total resection by intralesional curettage with case-dependent instrumented spinal fusion for instability remains an effective strategy for managing pediatric spinal ABCs. Long-term follow-up is necessary to detect tumor recurrence.

BACKGROUND

Aneurysmal bone cysts (ABCs) are rare, highly vascular osteolytic bone lesions that predominantly affect pediatric populations. This report evaluates the clinicopathological data of pediatric patients with spinal ABCs. The medical records for all patients at Children’s Hospital Los Angeles with biopsy-proven ABCs of the spine between 1998 and 2018 were evaluated.

OBSERVATIONS

Seventeen patients, 6 males and 11 females, were identified. The mean age at surgery was 10.4 years (range, 3.5–20 years). The most common presenting complaint was pain at the lesion site 16/17 (94%), followed by lower-extremity weakness 8/17 (47%). Resection and intralesional curettage were performed in all patients. Three (18%) of 17 patients underwent selective arterial embolization prior to resection. Spinal stability was compromised in 15 of 17 patients (88%), requiring instrumented fusion. Five (29%) of the 17 patients received additional therapy including radiation, calcitonin-methylprednisolone, or phenol. Four (23.5%) of 17 patients experienced a recurrence, and the mean time to recurrence was 15 months. The postoperative follow-up ranged from 6 to 108 months (median, 28 months). Reoperation occurred after an average of 35 months. At the recent follow-up, patients were free of disease.

LESSONS

Gross-total resection by intralesional curettage with case-dependent instrumented spinal fusion for instability remains an effective strategy for managing pediatric spinal ABCs. Long-term follow-up is necessary to detect tumor recurrence.

Aneurysmal bone cysts (ABCs) are rare, vascular, and aggressive bone tumors characterized by trabeculated connective tissue, fibroblasts, and osteoclast giant cells that surround variably sized blood-filled cavities.1–3 ABCs occur primarily in patients younger than 20 years old and represent approximately 1% of all primary bone tumors, with 1.4 cases per 100,000 individuals diagnosed annually.4,5 In an epidemiological review of 411 children with ABCs, the spine (14.7%) was noted to be the third most common site, after the femur (22.3%) and tibia (17.4%).4 Dorsal spinal locations (including the pedicle, pars, transverse process, and lamina) were affected more frequently than the vertebral body.6,7

Although ABCs derive from a benign neoplastic cell type, they can cause local bone tissue erosion and involve adjacent soft tissues, rendering clinical management challenging. ABCs can enter the spinal canal and yield symptoms of spinal cord compression; expansile ABCs can also compromise vertebral stability.8,9 Previously described therapeutic approaches to ABC management have included excision, targeted stereotactic radiotherapy, and selective arterial embolization (SAE).10 Surgical management of spinal ABCs requires attention to tumor accessibility, proximity to neural tissue, and an assessment of perioperative vertebral column stability.8 A recent systematic review of spinal ABCs showed an overall recurrence rate of 12.8%.10

In this retrospective case series, we contribute to the modest body of literature surrounding pediatric spinal ABCs. The medical records for all patients with biopsy-proven ABC of the spine between June 1998 and October 2018 were retrospectively reviewed. Demographic data (sex, age at presentation, time to presentation), clinical data (chief complaint, neurological symptoms, intervention, surgical details, clinical status on follow-up, complications, recurrence), and radiological data (location, spinal cord compression, pathological fracture, soft tissue involvement) were extracted.

Anterior ABCs were defined as lesions along the vertebral body, whereas posterior lesions were defined as within or posterior to the pedicle. Reoperation was defined as surgical tumor control for recurrence. Our analysis includes clinical presentation, surgical outcomes, and recurrence rates for 17 sequential pediatric patients with spinal ABC managed at Children’s Hospital Los Angeles over a period of 20 years. Individual case details are supplied for each patient who experienced a recurrence, as reporting on such instances is limited within the current literature.

Study Description

Clinical Presentation and Preoperative Radiological Evaluation

Table 1 details patient-specific preoperative data including clinicodemographic descriptions, presenting symptoms, and anatomical location. Seventeen patients (6 males, 11 females; ratio 1:1.8) were included in the analysis. Patients had a mean age of 10.4 years (range, 3.5–20 years) at the time of diagnosis. The average time from symptoms to diagnosis was 10 weeks. Eleven patients (64.7%) had an ABC located in the thoracic spine, 5 (29.4%) in the cervical spine, and 1 (5.9%) in the lumbar spine. The most common symptom was pain localized to the tumor site (94%), followed by lower-extremity weakness/inability to walk (47%) and paresthesia (29.4%). All 14 patients (82%) who initially presented with signs of lower-extremity weakness, an inability to walk, or parasthesias were found to have compression of the spinal cord on imaging.

TABLE 1

Clinical data on 17 pediatric patients with spinal ABCs

Case No.SexAge (yrs)Initial Sxs to Presentation (wks)Presenting SxsLevelAnatomical LocationCord CompressionSoft Tissue InvolvementPathologic FractureFU (mos)
1M168Ataxia, back pain, LE parasthesias/weaknessT3–4VB, La, Pd, TP, SPYesNoNo12
2F138Inability to walk, LE parasthesiasT4VB, La, Pd, TP, SPYesYesNo12
3F1512Low-back pain, LE parasthesiasT9VB, La, TP, SPYesNoNo36
4M5.512Neck painC3VB, La, TPNoNoYes36
5F85Rt leg pain, rt leg weakness, falls (×4)T8VB, Pd, TPYesYesYes108
6F93Neck painC2VB, La, SPNoNoNo48
7M3.58Neck painC6La, Pd, TP, SPYesYesNo24
8F1216Back painT12VB, PdNoYesNo6
9F1318Back pain, LE weakness, LE parasthesias, neurogenic bladderT4La, SPYesNoNo24
10M1120Back & LE pain, abdominal numbnessT2La, SP, TPYesNoYes18
11M1724Back/neck pain, lt shoulder painC2VB, La, Pd, TP, SPYesYesNo10
12F93Back pain, LE weakness, LE parasthesiasT9VB, La, Pd, TP, SP, lt inf & sup articulating facetsYesYesNo61
13F63Back pain, LE weaknessT12, L1VB, PdYesYesNo68
14F122Back pain, inability to walk, neurogenic bladderT9VB, La, Pd, TP, SPYesYesNo58
15F1313Back pain, inability to walk, neurogenic bladderT11–12VB, La, Pd, SPYesYesNo58
16M96Neck pain/immobility, arm weaknessC4VB, La, Pd, TP, articular pillarYesYesNo28
17F208Back painL3VB, La, Pd, TPYesNoYes7

FU = follow-up; inf = inferior; La = lamina; LE = lower extremity; Pd = pedicle; SP = spinous process; sup = superior; Sxs = symptoms; TP = transverse process; VB = vertebral body.

Preliminary diagnosis was made via preoperative imaging demonstrating lesions characteristic of ABCs for all patients. Representative preoperative cervical, thoracic, and lumbar images are shown in Figs. 13, respectively. Axial and sagittal T2-weighted magnetic resonance (MR) images demonstrating lesion fluid levels, soft tissue extension, and relationships to the spinal cord are displayed alongside computed tomography (CT) images showing the corresponding degree of bony destruction.

FIG. 1
FIG. 1

Representative images of 3 patients with cervical spine ABCs. Preoperative sagittal (A, C, I, K, Q, and S) and axial (B, D, J, L, R, and T) T2-weighted MR and CT images demonstrate cervical ABCs. Postoperative sagittal (E, M, and U) and axial (F, N, and V) T2-weighted MR images portray GTR, with instrumented fusion observed in the sagittal (G, O, and W) and coronal (H, P, and X) planes of radiographic images. The primary level of ABC involvement in cases 7, 11, and 16 are as follows: C6, C2, C4, respectively.

FIG. 2
FIG. 2

Representative images of 3 patients with thoracic spine ABCs. Preoperative sagittal (A, C, I, K, Q, and S) and axial (B, D, J, L, R, and T) T2-weighted MR and CT images demonstrate thoracic ABCs. Postoperative sagittal (E, M, and U) and axial (F, N, and V) T2-weighted MR images portray GTR, with instrumented fusion observed in the sagittal (G, O, and W) and coronal (H, P, and X) planes of the radiographic images. For case 12, a postoperative CT is shown in lieu of an MR image. The primary level of ABC involvement in cases 2, 12, and 15 are as follows: T4, T9, T12, respectively.

FIG. 3
FIG. 3

Representative images of 1 patient with a lumbar spine ABC. Preoperative sagittal (A) and axial (B) T2-weighted MR and CT (C) images demonstrate an ABC at L3. Postoperative sagittal (D), coronal (E), and axial (F) CT images portray GTR, with instrumented fusion observed in the sagittal (G) and coronal (H) planes of the radiographic images.

Operative Management and Outcomes

Supplementary Table 1 describes case operative details. All 17 patients with spinal ABCs were surgically managed, and diagnosis was confirmed by intraoperative frozen pathology. Preoperative SAE was performed for 3 patients (18%). The primary mode of treatment for all patients was resection achieved via a combination of curettes, rongeurs, high-speed burr, and electrocautery. The surgical approach was based on tumor extent and location; a posterior approach was adequate in 10 cases (59%), whereas 7 patients (41%) required combined anterior and posterior approaches. Corpectomy was completed via a posterior transpedicular approach in 5 (50%) of 10 posterior cases. Intraoperative sensory and motor evoked potential monitoring was used in 14 cases with cord compression (82%).

The average estimated blood loss (EBL) for initial anterior and/or posterior surgery was 914 mL, with 9 patients (53%) requiring intraoperative blood transfusion. Those patients with preoperative imaging concerning for high vascularity were selected for preoperative embolization. The EBL values for the patients who had undergone embolization prior to surgery were 600, 1,600, and 1,000 mL (cases 5, 6, and 16, respectively). Fifteen patients (88%) had tumor involvement that compromised spinal stability, requiring instrumented fusion. Posterior instrumented fusion was adequate in 12 cases (80%), whereas 3 patients (20%) underwent combined anterior/posterior instrumented fusion (Supplementary Table 1). Of those cases requiring fusion, 10 were in the thoracic spine (67%), 4 in the cervical spine (27%), and 1 in the lumbar spine (6%). Postoperative CT, MR, and radiographic images are provided for each of the representative patients (Figs. 13). Gross-total resection (GTR), defined by surgical impression and postoperative imaging, was achieved in all but 1 case (16/17, 94%).

Case Details of Patients With ABC Recurrence

Four patients (24%) had a recurrence of the primary tumor, requiring reoperation (Table 2).

TABLE 2

Long-term outcome data on 5 patients requiring re-operation of the spine

Case No.Time to Recurrence (mos)Presenting Sx on FUReason for Re-OpSpinal InstabilitySpinal FusionRadiotherapy
18Back painTumor controlNoYesNo
3NoneSevere junctional kyphosisKyphosis, hardware extensionNoYesNo
44Neck painTumor control (progression of remaining tumor after CM injection & later recurrence requiring 3rd op)YesYesYes
64Neck painTumor controlNoYesYes
1443Back painTumor controlYesNoNo

The patient in case 1 initially presented with back pain and ataxic gait. Imaging revealed an aggressive lesion involving the left pedicle of T4 with extension into the vertebral body, lamina, and transverse and spinous processes. The patient required anterior T4 corpectomy, T3–4 laminectomy, and T5 hemilaminectomy, along with T1–5 posterior fusion. Adjuvant phenol was placed around the vertebrae. The postoperative course was associated with a pneumothorax, which resolved spontaneously. The patient presented 8 months later with new back pain. MR images revealed an ABC recurrence on the right side of the resection cavity. The patient underwent reoperation with resection of the entire tumor. No adjuvant therapy was required. The patient was followed up for 20 months during which imaging showed no presence of tumor.

The patient in case 4 presented with an aggressive ABC at C3 with bony destruction of the vertebral body, transverse process, and left-sided lamina. A partial resection was performed because of a component anterior to the cord that could not be visualized from the initial posterior approach. A trial of percutaneous calcitonin-methylprednisolone (CM) therapy was attempted. After 3 months, the residual tumor demonstrated growth and the patient underwent a laminectomy of C2, C3, and part of C4 with removal of the pedicles and transverse processes of C2 and C3 bilaterally. Postoperative imaging revealed residual tumor involving the base of the dens, which was successfully treated with a course of radiation. The patient has been followed up for 9 years after radiation treatment and has not shown any radiographic evidence of tumor recurrence.

The patient in case 6 had undergone a C2 laminectomy at an outside institution. Because of excessive blood loss, the procedure was not completed and was emergently stopped. The volume of blood loss at the outside hospital could not be determined. The patient was subsequently transferred to our institution where SAE was performed, followed by complete resection via a C2 laminectomy and anterior C2 corpectomy. The patient was found to have radiological evidence of a recurrence 4 months postoperatively and underwent adjuvant radiation at that time. Four years after radiation, the patient remained without evidence of further recurrence.

The patient in case 14 presented with back pain and neurological deficits including lower-extremity weakness and a neurogenic bladder. The patient underwent total resection involving an anterior T9 partial corpectomy and posterior T9 laminectomy with spinal cord decompression and posterior T6–11 spinal fusion with the use of allograft and autograft. After 3.5 years, the patient reported back pain and was found to have radiographic evidence of a tumor recurrence at T9. During reoperation, we noted involvement of the remaining vertebral body, lamina, pedicles, transverse process, and spinous process, as well as soft tissue involvement and cord compression. This patient was followed up for 1.5 years and showed no evidence of recurrence.

Complications and Ultimate Outcomes

There were three postoperative complications (Supplementary Table 1). As detailed above, the patient in case 1 experienced a pneumothorax. The patient in case 9 had a residual neurological deficit of transient L1 paraparesis and bilateral pleural effusions that subsequently resolved spontaneously. Surgery for the patient in case 3 was complicated by an enterococcal wound infection, followed by the development of postlaminectomy kyphosis at the T9–10 level. This patient subsequently returned to the operating room for the removal of infected rods and extension of the fusion.

Supplementary Fig. 1 demonstrates a flowchart of patient outcomes for this cohort. At the time of the most recent follow-up (range, 6–108 months; median, 28 months), all patients were free of disease with no neurological abnormalities, no radiographic signs of tumor recurrence, and no evidence of progressive spinal deformity.

Patient Informed Consent

The necessary patient informed consent was obtained in this study.

Discussion

Observations

ABCs are rare, vascular, and aggressive bone tumors that present unique challenges when originating within the growing pediatric spine. In this series, we provide case details of our institution’s 20-year experience managing pediatric spinal ABCs. Our results support management with GTR and a case-by-case need for instrumented fusion as an effective surgical approach. For these rare lesions with a sparse literature base, the details provided here may support the future systematic review and meta-analysis required to inform treatment guidelines and best practices.

In this study, patients averaged 10.4 years (range, 3.5–20 years) at the time of diagnosis with an average of 10 weeks from symptom onset to diagnosis, consistent with other case series reporting from pediatric tertiary care centers.9,11 There was a female predilection (11:6), which supports the literature indicating a greater incidence of ABCs in the female pediatric population.5 The most common ABC location in this series was the thoracic spine, as documented in a recent series by Lu et al.11 (n = 24 patients). The literature cites the lumbar spine as the most common and the cervical spine as the least common location for spinal ABCs.9

The posterior elements and the pedicles are affected most commonly in spinal ABCs, although the lesion can frequently extend into the vertebral body.12 In the present series, 82% of patients presented with vertebral body involvement. Continued expansion and bony destruction of the vertebral body can lead to sudden collapse or acute compression of the spinal cord. Pathological fractures causing spinal cord or nerve root compression are reported to occur in as many as 20% of patients.9 In our series, 14 patients presented with cord compression and 3 with pathological fracture.

The locally destructive and invasive characteristics of spinal ABCs can cause irreversible damage to spinal structures and, as demonstrated by representative imaging in Figs. 13, often consume multiple vertebral levels. These images underscore the necessity of prompt treatment and a meticulous maximal resection response to limit damage to the spine. Effective spinal stabilization via posterior or combined posterior/anterior instrumented fusion was accomplished, which allowed for an aggressive resection.

Local recurrence of ABCs has been reported more frequently in children.13–15 Vergel De Dios et al.16 published a 19% recurrence rate in 153 patients, with recurrence typically occurring within the first 2 years. However, this analysis included adult patients and was not restricted to spinal ABCs. Parker et al.10 reported a 25% recurrence rate in a combination of pediatric and adult patients. We report an overall recurrence rate of 24%, with three-quarters of these cases recurring within the first 2 years.9 The importance of continued follow-up is highlighted by the time to recurrence in this cohort, ranging from 4 to 43 months. The follow-up period of our patients varied widely, and some patients may yet experience a recurrence. This bias should be included as a limitation of our study. The duration of follow-up, cadence, and CT versus MR imaging surveillance should be adapted to each individual patient depending on factors such as the severity of their initial disease, extent of resection, and presence of instrumentation.

The surgical outcomes and recurrences with respect to additional therapy are presented in Supplementary Fig. 1. The recurrence rate was 19% with GTR; as anticipated, the only patient who underwent subtotal resection (STR) experienced a recurrence. Of the 16 patients who underwent GTR in the present series, approximately three-quarters (77%) experienced definitive treatment and had excellent neurological outcomes with no lasting postoperative deficit following total resection. ABC recurrence management can present with complexities and is currently an area of ongoing research. A frequently utilized method involves using curettage in conjunction with adjuvant cauterization utilizing phenol.

Lessons

Some authors have advocated for the use of curettage with intraoperatively applied therapies such as phenol, liquid nitrogen, or argon beam coagulation.17–21 Liquid nitrogen and phenol can be limited in applicability because of the difficulty in controlling application to the tumor bed while avoiding contact with spinal dura and vascular supply. CM has also been used to promote the resolution of ABCs.22 CM was used as adjunct therapy in the one patient who had undergone STR and experienced a recurrence. Phenol was used intraoperatively (n = 1), with a postoperative recurrence observed at 8 months despite achieving GTR at the time of initial surgery.

Additional adjunct therapeutics include percutaneous embolization with zein (protein derived from corn meal), which has been used as a treatment option for ABC to induce thrombosis and fibrotic reaction within the ABC cavity.23 Whereas successful treatment has been described with this method, severe complications due to nontargeted embolization of the material have also been reported.24

The use of SAE to facilitate ABC resection by reducing intraoperative blood loss is well documented.25–30 The technique was used in 3 patients in the current series but did not reduce the blood loss compared with the rest of the cohort. Notably, the patient in case 6 had excessive EBL during the initial surgery at an outside institution. This patient subsequently underwent SAE, allowing the minimization of blood loss upon completion of the procedure at our institution.

Our study is not powered to make conclusions on the addition of therapies with embolization, phenol, or CM. These details are supplied to support future systematic reviews and meta-analyses, which will be required to make determinations on the efficacy of adjunct therapeutics.

Instrumented fusion was performed to prevent kyphotic deformity and postoperative structural instability and should be considered during posterior approaches when the facet complex is destabilized.31–35 The decision to pursue instrumentation was based on the destructive extent of the primary lesion and the degree to which multiple columns of the spinal axis were involved. Posterior instrumentation with lateral mass screws (cervical spine), pedicle screws (thoracic and lumbar spine), or hooks and rods can be effectively performed after posterior resection.12 If an anterior approach is necessary, the anterior column should be reconstructed with an interbody graft and plating.12,36

Our cohort is characterized by extensive ABCs with significant vertebral body involvement, and thus instrumented fusion was often performed to ensure spinal stability. We achieved spinal alignment by interbody graft and plating combined with instrumentation. Three patients underwent combined anterior and posterior instrumented fusion after anterior resection via a transpedicular approach (n = 5). A transpedicular approach can obviate the need for anterior spinal instrumentation. One patient required subsequent surgery for postjunctional kyphosis after instrumented fusion. Spinal alignment was ultimately achieved for all patients.

Our results contribute to the body of literature supporting GTR by intralesional curettage with a case-by-case need for instrumented fusion as an effective surgical approach for managing pediatric ABCs. Furthermore, this series provides case details of patients with ABC recurrence and highlights the importance of continued follow-up, as recurrence was diagnosed as late as approximately 3.5 years after the time of initial surgery.

Author Contributions

Conception and design: Chiarelli, Flyer, Vanstrum, Chapman, Krieger. Acquisition of data: Chiarelli, Flyer, Vanstrum, Chapman, Ha, Krieger. Analysis and interpretation of data: Chiarelli, Flyer, Vanstrum, Chapman, Ha, McComb, Krieger. Drafting the article: Chiarelli, Flyer, Vanstrum, Chapman, Ha, Krieger. Critically revising the article: all authors. Reviewed submitted version of manuscript: Chiarelli, Flyer, Vanstrum, Chapman, Ha, McComb, Durham, Krieger. Approved the final version of the manuscript on behalf of all authors: Chiarelli Statistical analysis: Chiarelli, Flyer, Krieger. Administrative/technical/material support: Chiarelli, Chapman, McComb, Durham, Krieger. Study supervision: Chiarelli, McComb, Durham, Krieger.

Supplemental Information

Online-Only Content

Supplemental material is available with the online version of the article.

Supplementary Table 1 and Fig. 1. http://thejns.org/doi/suppl/10.3171/CASE23637.

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    Rossi G, Rimondi E, Bartalena T, et al. Selective arterial embolization of 36 aneurysmal bone cysts of the skeleton with N-2-butyl cyanoacrylate. Skeletal Radiol. 2010;39(2):161167.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Yildirim E, Ersözlü S, Kirbaş I, Ozgür AF, Akkaya T, Karadeli E Treatment of pelvic aneurysmal bone cysts in two children: selective arterial embolization as an adjunct to curettage and bone grafting. Diagn Interv Radiol. 2007;13(1):4952.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Mohit AA, Eskridge J, Ellenbogen R, Shaffrey CI Aneurysmal bone cyst of the atlas: successful treatment through selective arterial embolization: case report. Neurosurgery. 2004;55(4):982.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Green JA, Bellemore MC, Marsden FW Embolization in the treatment of aneurysmal bone cysts. J Pediatr Orthop. 1997;17(4):440443.

  • 29

    Cigala F, Sadile F Arterial embolization of aneurysmal bone cysts in children. Bull Hosp Jt Dis. 1996;54(4):261264.

  • 30

    De Cristofaro R, Biagini R, Boriani S, et al. Selective arterial embolization in the treatment of aneurysmal bone cyst and angioma of bone. Skeletal Radiol. 1992;21(8):523527.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Boriani S, De Iure F, Campanacci L, et al. Aneurysmal bone cyst of the mobile spine: report on 41 cases. Spine (Phila Pa 1976). 2001;26(1):2735.

  • 32

    Hay MC, Paterson D, Taylor TK Aneurysmal bone cysts of the spine. J Bone Joint Surg Br. 1978;60-B(3):406411.

  • 33

    Ozaki T, Halm H, Hillmann A, Blasius S, Winkelmann W Aneurysmal bone cysts of the spine. Arch Orthop Trauma Surg. 1999;119(3-4):159162.

  • 34

    Friedrich H, Seifert V, Becker H Operative treatment of aneurysmal bone cysts of the spine -radical excision and spinal stabilization. In: Wenker H, Klinger M, Brock M, Reuter F, eds. Spinal cord tumors experimental neurosurgery neurosurgical intensive care. Advances in neurosurgery. Springer; 1986:116124.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Cybulski GR, Anson J, Gleason T, Homsi MF, Reyes MG Aneurysmal bone cyst of the thoracic spine: treatment by excision and segmental stabilization with Luque rods. Neurosurgery. 1989;24(2):273276.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Mehdian H, Weatherley C Combined anterior and posterior resection and spinal stabilization for aneurysmal bone cyst. Eur Spine J. 1995;4(2):123125.

Supplementary Materials

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  • FIG. 1

    Representative images of 3 patients with cervical spine ABCs. Preoperative sagittal (A, C, I, K, Q, and S) and axial (B, D, J, L, R, and T) T2-weighted MR and CT images demonstrate cervical ABCs. Postoperative sagittal (E, M, and U) and axial (F, N, and V) T2-weighted MR images portray GTR, with instrumented fusion observed in the sagittal (G, O, and W) and coronal (H, P, and X) planes of radiographic images. The primary level of ABC involvement in cases 7, 11, and 16 are as follows: C6, C2, C4, respectively.

  • FIG. 2

    Representative images of 3 patients with thoracic spine ABCs. Preoperative sagittal (A, C, I, K, Q, and S) and axial (B, D, J, L, R, and T) T2-weighted MR and CT images demonstrate thoracic ABCs. Postoperative sagittal (E, M, and U) and axial (F, N, and V) T2-weighted MR images portray GTR, with instrumented fusion observed in the sagittal (G, O, and W) and coronal (H, P, and X) planes of the radiographic images. For case 12, a postoperative CT is shown in lieu of an MR image. The primary level of ABC involvement in cases 2, 12, and 15 are as follows: T4, T9, T12, respectively.

  • FIG. 3

    Representative images of 1 patient with a lumbar spine ABC. Preoperative sagittal (A) and axial (B) T2-weighted MR and CT (C) images demonstrate an ABC at L3. Postoperative sagittal (D), coronal (E), and axial (F) CT images portray GTR, with instrumented fusion observed in the sagittal (G) and coronal (H) planes of the radiographic images.

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  • 25

    Rossi G, Rimondi E, Bartalena T, et al. Selective arterial embolization of 36 aneurysmal bone cysts of the skeleton with N-2-butyl cyanoacrylate. Skeletal Radiol. 2010;39(2):161167.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Yildirim E, Ersözlü S, Kirbaş I, Ozgür AF, Akkaya T, Karadeli E Treatment of pelvic aneurysmal bone cysts in two children: selective arterial embolization as an adjunct to curettage and bone grafting. Diagn Interv Radiol. 2007;13(1):4952.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Mohit AA, Eskridge J, Ellenbogen R, Shaffrey CI Aneurysmal bone cyst of the atlas: successful treatment through selective arterial embolization: case report. Neurosurgery. 2004;55(4):982.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Green JA, Bellemore MC, Marsden FW Embolization in the treatment of aneurysmal bone cysts. J Pediatr Orthop. 1997;17(4):440443.

  • 29

    Cigala F, Sadile F Arterial embolization of aneurysmal bone cysts in children. Bull Hosp Jt Dis. 1996;54(4):261264.

  • 30

    De Cristofaro R, Biagini R, Boriani S, et al. Selective arterial embolization in the treatment of aneurysmal bone cyst and angioma of bone. Skeletal Radiol. 1992;21(8):523527.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Boriani S, De Iure F, Campanacci L, et al. Aneurysmal bone cyst of the mobile spine: report on 41 cases. Spine (Phila Pa 1976). 2001;26(1):2735.

  • 32

    Hay MC, Paterson D, Taylor TK Aneurysmal bone cysts of the spine. J Bone Joint Surg Br. 1978;60-B(3):406411.

  • 33

    Ozaki T, Halm H, Hillmann A, Blasius S, Winkelmann W Aneurysmal bone cysts of the spine. Arch Orthop Trauma Surg. 1999;119(3-4):159162.

  • 34

    Friedrich H, Seifert V, Becker H Operative treatment of aneurysmal bone cysts of the spine -radical excision and spinal stabilization. In: Wenker H, Klinger M, Brock M, Reuter F, eds. Spinal cord tumors experimental neurosurgery neurosurgical intensive care. Advances in neurosurgery. Springer; 1986:116124.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Cybulski GR, Anson J, Gleason T, Homsi MF, Reyes MG Aneurysmal bone cyst of the thoracic spine: treatment by excision and segmental stabilization with Luque rods. Neurosurgery. 1989;24(2):273276.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Mehdian H, Weatherley C Combined anterior and posterior resection and spinal stabilization for aneurysmal bone cyst. Eur Spine J. 1995;4(2):123125.

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