Aneurysmal bone cyst of the spine. Management and outcome

The clinical records, radiographs, histologic sections, and operative reports of 52 consecutive patients with an aneurysmal bone cyst of the spine were reviewed to evaluate diagnostic and therapeutic options and to correlate treatment and outcome.

To define the incidence, clinical presentation, diagnostic and therapeutic options, and prognosis of patients with aneurysmal bone cyst of the spine.

There are special considerations in the management of spinal lesions: relative inaccessibility of the lesions, associated intraoperative bleeding, necessity of removing the entire lesion to avoid the possibility of recurrence, proximity of the lesion to the spinal cord and nerve roots, and potential postoperative bony spinal instability.

Fifty-two consecutive patients with an aneurysmal bone cyst of the spine were treated from 1910 to 1993. Forty patients initially treated for a primary lesion had operative treatment (19 intralesional excision and bone grafting and 21 intralesional excision); four also had adjuvant radiation therapy. Preoperative arterial embolization was performed in two.

There was a recurrence rate of 10% within 10 years. All recurrences were noted less than 6 months after surgery. Of 12 patients treated for a recurrent lesion, two had a subsequent recurrence (16.7%) within 9 years. At last follow-up examination, 50 patients (96%) were free of the disease. One patient died of postradiation osteosarcoma, and one died of intraoperative bleeding.

Current treatment recommendations involve preoperative selective arterial embolization, intralesional excision curettage, bone grafting, and fusion of the affected area if instability is present.