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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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Related in: MedlinePlus

a–m Case # 2 A 46-year-old female came with neck pain, left arm weakness for 4 months. Neurological examination showed a monoparesis of left upper extremity. MR and CT scans showed a tumor on the left side of C6 and C7 vertebral bodies. C6, C7 body, C7 lamina, pedicle, facet joint, left C6–C7 neural foramina. WBB scale was 1–8, 12 ABCD. A total spondylectomy was performed using a combined posterior, anterior and posterior approach. Spinal reconstruction was achieved using a fibula allograft, anterior cervical plate and posterior lateral mass screw-rod system. There was no recurrence during the 16-month follow-up period
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Fig3: a–m Case # 2 A 46-year-old female came with neck pain, left arm weakness for 4 months. Neurological examination showed a monoparesis of left upper extremity. MR and CT scans showed a tumor on the left side of C6 and C7 vertebral bodies. C6, C7 body, C7 lamina, pedicle, facet joint, left C6–C7 neural foramina. WBB scale was 1–8, 12 ABCD. A total spondylectomy was performed using a combined posterior, anterior and posterior approach. Spinal reconstruction was achieved using a fibula allograft, anterior cervical plate and posterior lateral mass screw-rod system. There was no recurrence during the 16-month follow-up period

Mentions: All patients underwent surgery. Total removal could be performed in 13 patients. It was a spondylectomy in one patient. Subtotal resection was performed in five patients. Surgical approaches were posterior alone (11), posterior and lateral (1), and combined anterior-posterior (6) (Figs. 2, 3). Combined approaches were done in one session in five cases, and separate sessions in one case. One patient had a repeat surgery due to recurrence. Six patients were instrumented in addition to tumor removal. Tumor bed was supported with polymethyl methacryate (PMMA) in three patients and with autografts and cage in four patients. On last follow-up, 13 patients have no evidence of disease and five cases are alive with disease (Table 3). As complication, one patient had cerebrospinal fluid (CSF) collection at the site of incision and two patients had significant bleeding during surgery which needed blood transfusion.Fig. 2


Aneurysmal bone cysts of the spine.

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

a–m Case # 2 A 46-year-old female came with neck pain, left arm weakness for 4 months. Neurological examination showed a monoparesis of left upper extremity. MR and CT scans showed a tumor on the left side of C6 and C7 vertebral bodies. C6, C7 body, C7 lamina, pedicle, facet joint, left C6–C7 neural foramina. WBB scale was 1–8, 12 ABCD. A total spondylectomy was performed using a combined posterior, anterior and posterior approach. Spinal reconstruction was achieved using a fibula allograft, anterior cervical plate and posterior lateral mass screw-rod system. There was no recurrence during the 16-month follow-up period
© Copyright Policy
Related In: Results  -  Collection

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

Fig3: a–m Case # 2 A 46-year-old female came with neck pain, left arm weakness for 4 months. Neurological examination showed a monoparesis of left upper extremity. MR and CT scans showed a tumor on the left side of C6 and C7 vertebral bodies. C6, C7 body, C7 lamina, pedicle, facet joint, left C6–C7 neural foramina. WBB scale was 1–8, 12 ABCD. A total spondylectomy was performed using a combined posterior, anterior and posterior approach. Spinal reconstruction was achieved using a fibula allograft, anterior cervical plate and posterior lateral mass screw-rod system. There was no recurrence during the 16-month follow-up period
Mentions: All patients underwent surgery. Total removal could be performed in 13 patients. It was a spondylectomy in one patient. Subtotal resection was performed in five patients. Surgical approaches were posterior alone (11), posterior and lateral (1), and combined anterior-posterior (6) (Figs. 2, 3). Combined approaches were done in one session in five cases, and separate sessions in one case. One patient had a repeat surgery due to recurrence. Six patients were instrumented in addition to tumor removal. Tumor bed was supported with polymethyl methacryate (PMMA) in three patients and with autografts and cage in four patients. On last follow-up, 13 patients have no evidence of disease and five cases are alive with disease (Table 3). As complication, one patient had cerebrospinal fluid (CSF) collection at the site of incision and two patients had significant bleeding during surgery which needed blood transfusion.Fig. 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