Management of spinal aneurysmal bone cyst: A case report

Aneurysmal bone cysts (ABCs) are reactive, proliferative, and highly vascular benign osseous lesions. They are very rare, and present significant diagnostic and treatment challenges.

For three months, an 18-year-old male developed progressive low back pain and mid-low back swelling. The computed tomography (CT) scan showed a mass invading the L1 vertebral body and right pedicle. The Magnetic resonance imaging (MRI) documented a complex cystic, osteolytic lesion measuring 7 cm × 7.7 cm × 5 cm that displaced the thecal sac to the left. After the biopsy confirmed an ABC, the patient underwent pre-operative embolization that reduced the vascularity by 80%; this was succeeded by en bloc total lesion resection with an instrumented fusion.

ABCs rarely occur in the lumbar spine. The diagnosis should be established and confirmed utilizing both MR and CT studies. Biopsy should be followed by embolization (i.e., if appropriate), and gross total surgical resection with fusion if warranted.