Surgical Management of Aneurysmal Bone Cysts of the Spine

James K. Liu, M.D.; Douglas L. Brockmeyer, M.D.; Andrew T. Dailey, M.D.; Meic H. Schmidt, M.D.

Disclosures

Neurosurg Focus. 2003;15(5) 

In This Article

Abstract and Introduction

Object: Aneurysmal bone cysts of the spine are benign, highly vascular osseous lesions of unknown origin that may present difficult diagnostic and therapeutic challenges. They are expansile lesions containing thin-walled, blood-filled cystic cavities that cause bone destruction and sometimes spinal deformity and neurological compromise. The treatment of aneurysmal bone cysts of the spine remains controversial according to the literature. In this review, the authors discuss the clinical manifestations, pathophysiological features, neuroimaging characteristics, and treatment strategies for these lesions.
Methods: Treatment options include simple curettage with bone grafting, complete excision, embolization, and radiation therapy. Reconstruction and stabilization of the spine may be warranted if deformity and instability are present. Special factors need to be considered in the management of these lesions.
Conclusions: Complete excision of aneurysmal bone cysts offers the best chance of cure and spinal decompression if neurological deficits are present.

Aneurysmal bone cysts were initially described as a distinct clinicopathological entity by Jaffe and Lichtenstein[27] in 1942. Although these lesions are generally regarded as nonneoplastic in nature, they are expansile tumors containing thin-walled, blood-filled cystic cavities, and they frequently affect the pediatric population. Aneurysmal bone cysts comprise approximately 1.4% of all bone tumors and 15% of all primary spine tumors.[1,13] Although they can involve any bone in the skeleton, aneurysmal bone cysts most frequently affect the flat bones of the pelvis and the metaphysis of long bones. Approximately 10 to 30% of cases involve the spine, most commonly in the thoracic and lumbar regions.[1,2,5,15,26,40,43] In these cases, the lesions generally arise in the posterior elements of the spine and can expand and extend into the pedicles, VB, and spinal canal, resulting in pathological fracture and neurological compromise. A progressive neurological deficit with acute paraplegia can occur. On rare occasions, some of these bone cysts become quiescent or undergo spontaneous regression. The unique location of this lesion in the spine presents several challenges in its surgical management.[56]

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