Vertebra plana due to an aneurysmal bone cyst of the lumbar spine

Case report and review of the literature

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✓ 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.

Abbreviations used in this paper:ABC = aneurysmal bone cyst; CT = computed tomography; MR = magnetic resonance; VB = vertebral body.

Article Information

Address reprint requests to: Edward R. Smith, M.D., Department of Neurosurgery, Children’s Hospital of Boston, 300 Longwood Avenue, Boston, Massachusetts 02115. email: edward.smith@childrens.harvard.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Lateral plain radiograph of the lumbar spine notable for fracture of the L-3 vertebra.

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    Consecutive sagittal T2-weighted MR images demonstrating vertebra plana of the L-3 vertebra, with mild narrowing of the spinal canal.

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    Axial CT scan (left) and T2-weighted MR image (right) of the L-3 vertebra. The CT scan is notable for a variable-density multilocular, cystic lesion with characteristic soap-bubble appearance. The MR image demonstrates multiple fluid-fluid levels separated by thin septations. These radiographic findings are consistent with an ABC.

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    Preembolization (left) and postembolization (right) angiograms of the principal lumbar artery supplying the ABC lesion. The dashed outline emphasizes the decreased flow to the lesion’s hypervascular region following selective arterial embolization. The arrow identifies the site of the embolization in the vessel (note the filling defect).

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