Aneurysmal bone cyst: surgical management in the pediatric cervical spine

Case report.

To present 2 cases of aneurysmal bone cyst in the cervical spine of children who were aggressively treated with resection, fusion, and stabilization with hardware to achieve complete cure and future stability.

Aneurysmal bone cyst is a rapidly expanding and destructive bone lesion of unknown etiology. Current approaches to treatment include surgical en bloc excision, complete curettage, selective arterial embolization, radiotherapy, and intralesional injection with a sclerosing agent. Fusion and stabilization with instrumentation have often been avoided in children due to concerns over instability following future axial skeleton growth.

The authors present 2 case reports of aneurysmal bone cyst in the cervical spine of children, both demonstrating deeply involved lesions with extensive bone destruction. Both were treated aggressively with resection, fusion, and stabilization with instrumentation. Additionally, the relevant background literature is briefly discussed.

Both patients had an uncomplicated postoperative course. At 36- and 18-month follow-up, both patients have no cervical spine instability or recurrence of tumor.

Treatment of aneurysmal bone cyst in the cervical spine is challenging when it occurs in close proximity to neural and vascular structures. Future stability of the cervical spine is a concern, especially when there is significant involvement of the vertebral body and posterior elements. At 36- and 18-month follow-up, the surgical approach to aneurysmal bone cyst presented here provided these patients with complete curative treatment and preservation of cervical spine stability.