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Aneurysmal bone cysts of the spine.

Zileli M, Isik HS, Ogut FE, Is M, Cagli S, Calli C - Eur Spine J (2012)

Bottom Line: Posterior (11), anterolateral (1), or combined anterior-posterior (6) approaches were used.Mean follow-up duration was 112.3 months (range 4-21 years).Radical surgical excision should be the goal of surgery to decrease the recurrence rate.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Ege University, Izmir, Turkey. zilelim@gmail.com

ABSTRACT

Purpose: Aneurysmal bone cyst is a benign, relatively uncommon lesion, representing 1.4 % of primary bone tumors. The vertebral column is involved in 3-30 % of cases. This report describes clinical characteristics and treatment results of 18 patients with aneurysmal bone cyst of the spine.

Methods: Between 1991 and 2008, 18 patients with aneurysmal bone cyst of the spine were surgically treated in our department. The clinical records, radiographs, histologic sections, and operative reports were analyzed.

Results: There were 11 male and 7 female patients; mean age was 22.1 years (range 7-46 years). Localizations were cervical (3), cervicothoracic (2), thoracic (3), lumbar (4), and sacrum (6). Tumor was localized on the left side in 11 cases, on the right side in 2 and at midline in 5 patients. The two most common clinical features were axial pain (14 patients) and radicular pain (8 patients). Neurological signs were paraparesis in 3, monoparesis in 6. Mean duration of symptoms was 9 months (range 3 months-3 years). All patients underwent surgery: total removal was performed in 13 patients and subtotal resection in 5. Posterior (11), anterolateral (1), or combined anterior-posterior (6) approaches were used. Mean follow-up duration was 112.3 months (range 4-21 years). We detected four recurrences in subtotal excision group (4/5), and one recurrence in total excision group (1/13).

Conclusion: Treatment options for aneurysmal bone cysts are simple curettage with or without bone grafting, complete excision, embolization, radiation therapy, or a combination of these modalities. Radical surgical excision should be the goal of surgery to decrease the recurrence rate. Recurrence rate is significantly lower in case of total excision.

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WBB (Weinstein, Boriani, Biagnini) Surgical Staging System. The transverse extension of the vertebral tumor is described with reference to 12 radiating zones (numbered 1–12 in a clockwise order) and to five concentric layers (A–E, from the paravertebral extraosseous compartments to the dural involvement). The longitudinal extent of the tumor is recorded according to the levels involved. From Boriani [9]
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Fig1: WBB (Weinstein, Boriani, Biagnini) Surgical Staging System. The transverse extension of the vertebral tumor is described with reference to 12 radiating zones (numbered 1–12 in a clockwise order) and to five concentric layers (A–E, from the paravertebral extraosseous compartments to the dural involvement). The longitudinal extent of the tumor is recorded according to the levels involved. From Boriani [9]

Mentions: Direct radiology disclosed bone erosion in 15 cases. MRI was carried out in 17 patients; one patient underwent CT myelography for diagnosis. Among 17 patients diagnosed with MRI, bone edema was present in six cases. Vascularization was moderate in nine patients, prominent in six, and there were no signs of vascularization in two cases. Upon radiological examination with CT scan or MRI, canal compression was verified in 13 patients: 5 were mild, three were moderate, and 6 were severe. There was no canal compression in four patients. Paravertebral soft tissue mass was determined in 15 cases. There were fluid–fluid levels in 10 cases (Table 2). According to Weinstein, Boriani, Biagini [8, 9] (WBB, Fig. 1) surgical staging, 17 cases were stage ABCD and one patient was stage ABC.Table 2


Aneurysmal bone cysts of the spine.

Zileli M, Isik HS, Ogut FE, Is M, Cagli S, Calli C - Eur Spine J (2012)

WBB (Weinstein, Boriani, Biagnini) Surgical Staging System. The transverse extension of the vertebral tumor is described with reference to 12 radiating zones (numbered 1–12 in a clockwise order) and to five concentric layers (A–E, from the paravertebral extraosseous compartments to the dural involvement). The longitudinal extent of the tumor is recorded according to the levels involved. From Boriani [9]
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3585636&req=5

Fig1: WBB (Weinstein, Boriani, Biagnini) Surgical Staging System. The transverse extension of the vertebral tumor is described with reference to 12 radiating zones (numbered 1–12 in a clockwise order) and to five concentric layers (A–E, from the paravertebral extraosseous compartments to the dural involvement). The longitudinal extent of the tumor is recorded according to the levels involved. From Boriani [9]
Mentions: Direct radiology disclosed bone erosion in 15 cases. MRI was carried out in 17 patients; one patient underwent CT myelography for diagnosis. Among 17 patients diagnosed with MRI, bone edema was present in six cases. Vascularization was moderate in nine patients, prominent in six, and there were no signs of vascularization in two cases. Upon radiological examination with CT scan or MRI, canal compression was verified in 13 patients: 5 were mild, three were moderate, and 6 were severe. There was no canal compression in four patients. Paravertebral soft tissue mass was determined in 15 cases. There were fluid–fluid levels in 10 cases (Table 2). According to Weinstein, Boriani, Biagini [8, 9] (WBB, Fig. 1) surgical staging, 17 cases were stage ABCD and one patient was stage ABC.Table 2

Bottom Line: Posterior (11), anterolateral (1), or combined anterior-posterior (6) approaches were used.Mean follow-up duration was 112.3 months (range 4-21 years).Radical surgical excision should be the goal of surgery to decrease the recurrence rate.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Ege University, Izmir, Turkey. zilelim@gmail.com

ABSTRACT

Purpose: Aneurysmal bone cyst is a benign, relatively uncommon lesion, representing 1.4 % of primary bone tumors. The vertebral column is involved in 3-30 % of cases. This report describes clinical characteristics and treatment results of 18 patients with aneurysmal bone cyst of the spine.

Methods: Between 1991 and 2008, 18 patients with aneurysmal bone cyst of the spine were surgically treated in our department. The clinical records, radiographs, histologic sections, and operative reports were analyzed.

Results: There were 11 male and 7 female patients; mean age was 22.1 years (range 7-46 years). Localizations were cervical (3), cervicothoracic (2), thoracic (3), lumbar (4), and sacrum (6). Tumor was localized on the left side in 11 cases, on the right side in 2 and at midline in 5 patients. The two most common clinical features were axial pain (14 patients) and radicular pain (8 patients). Neurological signs were paraparesis in 3, monoparesis in 6. Mean duration of symptoms was 9 months (range 3 months-3 years). All patients underwent surgery: total removal was performed in 13 patients and subtotal resection in 5. Posterior (11), anterolateral (1), or combined anterior-posterior (6) approaches were used. Mean follow-up duration was 112.3 months (range 4-21 years). We detected four recurrences in subtotal excision group (4/5), and one recurrence in total excision group (1/13).

Conclusion: Treatment options for aneurysmal bone cysts are simple curettage with or without bone grafting, complete excision, embolization, radiation therapy, or a combination of these modalities. Radical surgical excision should be the goal of surgery to decrease the recurrence rate. Recurrence rate is significantly lower in case of total excision.

Show MeSH
Related in: MedlinePlus