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

Clinical article

Georgios ZenonosDepartment of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and

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Osama JamilDepartments of Neurological Surgery and

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Lance S. GovernaleDepartments of Neurological Surgery and

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Sarah JerniganDepartments of Neurological Surgery and

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Daniel HedequistOrthopedic Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts

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Mark R. ProctorDepartments of Neurological Surgery and

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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.

Abbreviations used in this paper:

ABC = aneurysmal bone cyst; EBL = estimated blood loss; GTR = gross-total resection; SAE = selective arterial embolization.
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  • 1

    Adamsbaum C, , Kalifa G, , Seringe R, & Dubousset J: Direct Ethibloc injection in benign bone cysts: preliminary report on four patients. Skeletal Radiol 22:317320, 1993

    • Search Google Scholar
    • Export Citation
  • 2

    Ameli NO, , Abbassioun K, , Saleh H, & Eslamdoost A: Aneurysmal bone cysts of the spine. Report of 17 cases. J Neurosurg 63:685690, 1985

  • 3

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

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Burch S, , Hu S, & Berven S: Aneurysmal bone cysts of the spine. Neurosurg Clin N Am 19:4147, 2008

  • 5

    Capanna R, , Albisinni U, , Picci P, , Calderoni P, , Campanacci M, & Springfield DS: Aneurysmal bone cyst of the spine. J Bone Joint Surg Am 67:527531, 1985

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Chan MS, , Wong YC, , Yuen MK, & Lam D: Spinal aneurysmal bone cyst causing acute cord compression without vertebral collapse: CT and MRI findings. Pediatr Radiol 32:601604, 2002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Clayer M: Injectable form of calcium sulphate as treatment of aneurysmal bone cysts. ANZ J Surg 78:366370, 2008

  • 8

    Codd PJ, , Riesenburger RI, , Klimo P Jr, , Slotkin JR, & Smith ER: Vertebra plana due to an aneurysmal bone cyst of the lumbar spine. Case report and review of the literature. J Neurosurg 105:6 Suppl 490495, 2006

    • Search Google Scholar
    • Export Citation
  • 9

    Cohen MC, , Drut R, , Garcia C, & Kaschula RO: Mesenchymal hamartoma of the chest wall: a cooperative study with review of the literature. Pediatr Pathol 12:525534, 1992

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Cottalorda J, & Bourelle S: Modern concepts of primary aneurysmal bone cyst. Arch Orthop Trauma Surg 127:105114, 2007

  • 11

    Cottalorda J, , Kohler R, , Sales de Gauzy J, , Chotel F, , Mazda K, & Lefort G, et al.: Epidemiology of aneurysmal bone cyst in children: a multicenter study and literature review. J Pediatr Orthop B 13:389394, 2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    De Cristofaro R, , Biagini R, , Boriani S, , Ricci S, , Ruggieri P, & Rossi G, et al.: Selective arterial embolization in the treatment of aneurysmal bone cyst and angioma of bone. Skeletal Radiol 21:523527, 1992

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    de Kleuver M, , van der Heul RO, & Veraart BE: Aneurysmal bone cyst of the spine: 31 cases and the importance of the surgical approach. J Pediatr Orthop B 7:286292, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Deo SD, , Fairbank JC, , Wilson-Macdonald J, , Richards P, , Pike M, & Athanasou N, et al.: Aneurysmal bone cyst as a rare cause of spinal cord compression in a young child. Spine (Phila Pa 1976) 30:E80E82, 2005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    DeRosa GP, , Graziano GP, & Scott J: Arterial embolization of aneurysmal bone cyst of the lumbar spine. A report of two cases. J Bone Joint Surg Am 72:777780, 1990

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Fletcher CDM, , Unni KK, & Mertens F: Pathology and Genetics of Tumours of Soft Tissue and Bone (IARC World Health Organization Classification of Tumours) ed 3 Lyons, IARC Press, 338340, 2006

    • Search Google Scholar
    • Export Citation
  • 17

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

  • 18

    Hoeffel JC, , Bernhard C, & Regent D: CT appearances of an aneurysmal cyst of the spine in childhood. Rontgenblatter 43:169170, 1990

  • 19

    Jaffe HL: Aneurysmal bone cyst. Bull Hosp Jt Dis 11:313, 1950

  • 20

    Keenan S, & Bui-Mansfield LT: Musculoskeletal lesions with fluid-fluid level: a pictorial essay. J Comput Assist Tomogr 30:517524, 2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21

    Koci TM, , Mehringer CM, , Yamagata N, & Chiang F: Aneurysmal bone cyst of the thoracic spine: evolution after particulate embolization. AJNR Am J Neuroradiol 16:4 Suppl 857860, 1995

    • Search Google Scholar
    • Export Citation
  • 22

    Kransdorf MJ, & Sweet DE: Aneurysmal bone cyst: concept, controversy, clinical presentation, and imaging. AJR Am J Roentgenol 164:573580, 1995

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Leithner A, , Windhager R, , Lang S, , Haas OA, , Kainberger F, & Kotz R: Aneurysmal bone cyst. A population based epidemiologic study and literature review. Clin Orthop Relat Res 363:176179, 1999

    • Search Google Scholar
    • Export Citation
  • 24

    Lichtenstein L: Aneurysmal bone cyst; observations on fifty cases. J Bone Joint Surg Am 39-A:873882, 1957

  • 25

    Liu JK, , Brockmeyer DL, , Dailey AT, & Schmidt MH: Surgical management of aneurysmal bone cysts of the spine. Neurosurg Focus 15:5 E4, 2003

  • 26

    MacCarty CS, , Dahlin DC, , Doyle JB Jr, , Lipscomb PR, & Pugh DG: Aneurysmal bone cysts of the neural axis. J Neurosurg 18:671677, 1961

  • 27

    Mahnken AH, , Nolte-Ernsting CC, , Wildberger JE, , Heussen N, , Adam G, & Wirtz DC, et al.: Aneurysmal bone cyst: value of MR imaging and conventional radiography. Eur Radiol 13:11181124, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28

    Murphey MD, , Andrews CL, , Flemming DJ, , Temple HT, , Smith WS, & Smirniotopoulos JG: From the archives of the AFIP. Primary tumors of the spine: radiologic pathologic correlation. Radiographics 16:11311158, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29

    Oda Y, , Tsuneyoshi M, & Shinohara N: “Solid” variant of aneurysmal bone cyst (extragnathic giant cell reparative granuloma) in the axial skeleton and long bones. A study of its morphologic spectrum and distinction from allied giant cell lesions. Cancer 70:26422649, 1992

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30

    Ozaki T, , Halm H, , Hillmann A, , Blasius S, & Winkelmann W: Aneurysmal bone cysts of the spine. Arch Orthop Trauma Surg 119:159162, 1999

  • 31

    Papagelopoulos PJ, , Currier BL, , Galanis EC, & Sim FH: Vertebra plana of the lumbar spine caused by an aneurysmal bone cyst: a case report. Am J Orthop 28:119124, 1999

    • Search Google Scholar
    • Export Citation
  • 32

    Papagelopoulos PJ, , Currier BL, , Shaughnessy WJ, , Sim FH, , Ebsersold MJ, & Bond JR, et al.: Aneurysmal bone cyst of the spine. Management and outcome. Spine (Phila Pa 1976) 23:621628, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33

    Peraud A, , Drake JM, , Armstrong D, , Hedden D, , Babyn P, & Wilson G: Fatal ethibloc embolization of vertebrobasilar system following percutaneous injection into aneurysmal bone cyst of the second cervical vertebra. AJNR Am J Neuroradiol 25:11161120, 2004

    • Search Google Scholar
    • Export Citation
  • 34

    Rossi G, , Rimondi E, , Bartalena T, , Gerardi A, , Alberghini M, & Staals EL, et al.: Selective arterial embolization of 36 aneurysmal bone cysts of the skeleton with N-2-butyl cyanoacrylate. Skeletal Radiol 39:161167, 2010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35

    Schreuder HW, , Veth RP, , Pruszczynski M, , Lemmens JA, , Koops HS, & Molenaar WM: Aneurysmal bone cysts treated by curettage, cryotherapy and bone grafting. J Bone Joint Surg Br 79:2025, 1997

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36

    Topouchian V, , Mazda K, , Hamze B, , Laredo JD, & Penneçot GF: Aneurysmal bone cysts in children: complications of fibrosing agent injection. Radiology 232:522526, 2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37

    Vergel De Dios AM, , Bond JR, , Shives TC, , McLeod RA, & Unni KK: Aneurysmal bone cyst. A clinicopathologic study of 238 cases. Cancer 69:29212931, 1992

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38

    Winter A, & Firtel S: Aneurysmal bone cyst of vertebra with compression symptoms. A case report. JAMA 177:870871, 1961

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