Multiple Treatment Analysis of Aneurysmal Bone Cysts in Mobile Spine

Study DesignRetrospective Cohort Study.ObjectivesTherapeutic strategies for Aneurysmal Bone Cysts (ABCs) of the spine remain controversial and encompass several modalities, including open surgery (ie, intralesional curettage and/or en bloc resection), localized injections, and pharmacotherapy. This study was designed to retrospectively analyze the clinical data from patients treated at our institution, with the objective of evaluating the clinical outcomes, safety profile, and efficacy of different treatments including open surgery, percutaneous injections of a doxycycline-albumin suspension, and Denosumab therapy in the management of these lesions, thereby establishing a basis for a comprehensive treatment algorithm.MethodsFrom January 2010 to December 2024, 27 patients who had no/minor neurological deficits (modified Frankel scale D or E) were included in the study, of whom 6 were treated with open surgery (surgery group), 14 were treated with percutaneous doxycycline/albumin injection (injection group) and 7 were treated with Denosumab (Denosumab group). The demographic and clinical information of these groups were recorded and compared.ResultsIn the surgery cohort (n = 6), complete neurological recovery was achieved in 5 patients (83.3%), while 1 patient experienced residual minor paresthesia; their mean Visual Analogue Scale (VAS) score decreased from 4.9 to 0.8. Two patients developed local recurrence over a mean follow-up period of 46.6 months (range, 15-113 months). In the injection cohort (n = 14), all patients demonstrated a significant reduction in lesion size and resumed normal daily activities. Complete symptomatic resolution was reported in 10 patients; 4 achieved partial resolution, with only mild, exertion-related local pain. Their mean VAS score decreased from 4.9 to 0.7. During a mean follow-up of 68.1 months (range, 7-117 months), no complications or recurrences were observed. In the Denosumab cohort (n = 7), all patients exhibited a significant reduction in lesion size and resumed normal activities. Complete symptomatic resolution was achieved in 6 patients, while 1 experienced partial resolution, characterized by intermittent, mild upper extremity weakness. Their mean VAS score decreased from 4.8 to 0.24. No complications or recurrences were documented over a median follow-up of 9.5 months (range, 1-88 months). No significant differences were observed among the cohorts regarding the rates of recurrence (P = 0.227) or complications (P = 0.304).ConclusionsFor patients presenting with spinal ABCs characterized by an absence of severe neurological deficits, both intralesional injection and systemic drug therapy are effective minimally invasive treatment options and can be considered as first-line choices. However, while both approaches demonstrate favorable short-term efficacy, their long-term outcomes require further investigation. Although not the preferred initial treatment, open surgery remains a crucial option for rapidly correcting spinal instability and reversing neurological deficits.