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Aneurysmal bone cyst of the cervical spine in children
Eduardo N Novais1, Peter S Rose, Michael J Yaszemski
1Department of Orthopaedic Surgery, University of Colorado, The Children's Hospital, 13123 East 16th Avenue, Aurora, CO 80045, USA.
Insights
Surgical treatment for pediatric cervical spine aneurysmal bone cysts, including intralesional curettage and spinal fusion, shows satisfactory outcomes. This approach for aneurysmal bone cysts (ABCs) in children results in low complication and recurrence rates.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Spinal Oncology
Background:
- Aneurysmal bone cysts (ABCs) frequently affect the pediatric spine, posing management challenges due to proximity to vital structures.
- Surgical intervention is often necessary for locally aggressive benign spinal tumors like ABCs.
Purpose of the Study:
- To evaluate the clinical presentation and surgical treatment outcomes of pediatric cervical spine ABCs.
- To assess the efficacy of intralesional curettage and spinal arthrodesis for these tumors.
Main Methods:
- Retrospective review of seven pediatric patients with cervical spine ABCs treated between 1988 and 2008.
- Surgical treatment involved complete intralesional curettage and spinal arthrodesis, sometimes with preoperative embolization.
Main Results:
- Neck pain and radiculopathy were the most common symptoms and signs.
- Four patients required combined anterior and posterior approaches; two needed additional procedures for recurrence or nonunion.
- All patients achieved tumor-free status at follow-up, with one experiencing Horner syndrome.
Conclusions:
- Preoperative embolization, thorough intralesional tumor excision, and spinal fusion provide effective treatment for pediatric cervical spine ABCs.
- This combined approach yields satisfactory results with low complication and recurrence rates in pediatric patients.
Background:
Approximately 50% of patients with aneurysmal bone cyst of the spine are in the pediatric age group. Aneurysmal bone cyst is considered a locally aggressive benign tumor that may involve the posterior and anterior elements of the spine. Intralesional extended curettage and bone-grafting is the mainstay of treatment of aneurysmal bone cysts involving the long bones. However, the proximity to neurovascular structures and the potential remaining growth of the spine make its management in the spine more challenging. We evaluated the clinical presentation and the results of surgical treatment, following complete intralesional curettage along with spinal arthrodesis in pediatric patients with aneurysmal bone cysts of the cervical spine.
Methods:
We retrospectively reviewed the cases of seven children who were surgically treated for a primary aneurysmal bone cyst of the cervical spine between 1988 and 2008. There were four boys and three girls who had a mean age of 11.9 years (range, eight to 16.2 years) at the time of diagnosis. The mean duration of follow-up was 46.5 months (range, twenty-six to ninety-eight months). The mean age at the time of follow-up was sixteen years (range, 10.6 to 24.6 years).
Results:
Neck pain was the most common presenting symptom, and radiculopathy was the most common finding on physical examination. Radiographs, computed tomography, and magnetic resonance imaging were highly suggestive for the diagnosis that was confirmed histologically in all patients. The majority (four) of the patients required combined anterior and posterior approaches for complete removal of the tumor and arthrodesis of the spine. Two patients required additional procedures: one for a local recurrence and one for nonunion of the atlantooccipital junction. All patients were free of evidence of recurrent disease at the time of the last follow-up. With the exception of one patient who had permanent Horner syndrome, all patients were asymptomatic.
Conclusions:
Preoperative arterial embolization, complete tumor excision by intralesional curettage and burring, followed by local spinal fusion, yield satisfactory results with a low rate of complications and low recurrence in children with an aneurysmal bone cyst of the cervical spine.
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