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Aneurysmal bone cyst as a rare cause of spinal cord compression in a young child
Sunny D Deo1, Jeremy C T Fairbank, James Wilson-Macdonald
1Great Western Hospital, Swindon, United Kingdom.
Insights
This case report details a rare pediatric aneurysmal bone cyst in a 2-year-old, successfully treated with innovative spinal stabilization techniques. The 7-year follow-up demonstrates the efficacy of adapted maxillofacial implants for pediatric spinal surgery.
Area of Science:
- Pediatric Neurosurgery
- Spinal Oncology
- Pediatric Orthopedics
Background:
- Aneurysmal bone cysts (ABCs) are rare spinal tumors in children, typically presenting in adolescence.
- Cases below age 4 are exceptionally rare, with limited data on management strategies.
- Standard spinal implant systems are often unsuitable for very young children.
Observation:
- A 2-year-old girl presented with cervicothoracic spinal cord compression due to an aneurysmal bone cyst.
- The tumor required complex anterior and posterior surgical excision and reconstruction.
- The patient experienced transient neurological deficits and a post-operative infection and recurrence.
Findings:
- A novel surgical technique utilizing maxillofacial implants and a fibular graft achieved spinal stabilization.
- Despite complications, including infection and recurrence, the patient achieved a 7-year recurrence-free follow-up.
- Adapted maxillofacial plates and titanium cables provided effective fixation in a very small spine.
Implications:
- This case highlights the feasibility of using adapted maxillofacial implants for pediatric spinal reconstruction.
- It provides valuable insights into managing rare pediatric spinal ABCs with cord compression.
- The successful outcome underscores the importance of tailored surgical approaches for complex pediatric spinal conditions.
Study Design:
Case report.
Objectives:
To report: 1) one of the youngest cases of aneurysmal bone cysts presenting with cord compression at the cervicothoracic junction with 7-year follow-up; and 2) the technique we used to stabilize such a small spine.
Summary Of Background Data:
Aneurysmal bone cyst is an uncommon but well-recognized tumor affecting the spine of children. The mean age of presentation is 16 years. It has hardly been reported below the age of 4 years. All data are in the form of case reports or series. Surgical or nonoperative management can be used. Spinal implant systems are not designed for use in very small children.
Methods:
Clinical data analysis.
Results:
A girl presented at age 2 years and 3 months with cord compression at the cervicothoracic junction. After an inconclusive biopsy, a formal excision and reconstruction of the C7 and T1 were performed anteriorly and posteriorly. We used a fibular graft, internal fixation with crossed plates from the maxillofacial implant tray and a Cervifix rod contoured into a rectangle with sublaminar titanium cables. Postsurgery, she had a left Horner syndrome that has never recovered and motor weakness of the right arm that improved but did not fully recover. She developed a staphylococcal infection 6 months postsurgery that was managed by removal of the rectangle. She developed a posterior recurrence 10 months postsurgery, which was managed surgically. Follow-up has been for 7 years without further evidence of recurrence.
Conclusions:
Both surgical and nonsurgical management has been advocated for these tumors. The cord compression at presentation forced us toward surgical management. It is likely that observational data are the only evidence available for clinical decision-making. In this case, we were able to obtain good access to the front of the upper thoracic spine by a supraclavicular approach. Tiny plates are available to maxillofacial surgeons that can be adapted for use in the spines of small children.
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