Aneurysmal bone cysts of the spine: treatment options and considerations

Abstract

Aneurysmal bone cysts (ABCs) are benign bone lesions with annual incidences ranging from 1.4 to 3.2 cases per million people. Approximately, 10-30% of ABCs are found in the spine. Such lesions are traditionally treated with curettage or other intralesional techniques. Because ABCs can be locally aggressive, intralesional resection can be incomplete and result in recurrence. This has led to increased use of novel techniques, including selective arterial embolization (SAE). This study aims to: (1) compare outcomes based on extent of surgical resection, and (2) compare the efficacy of SAE versus surgical resection. Clinical data pertaining to 71 cases of spinal ABCs were ambispectively collected from nine institutions in Europe, North America, and Australia. Twenty-two spinal ABCs were treated with surgery, 32 received preoperative embolization and surgery, and 17 were treated with SAE. Most tumors were classified as Enneking stage 2 (n = 29, 41%) and stage 3 (n = 29, 41%). Local recurrence and survival were investigated and a significant difference was not observed between treatment groups. However, all three local recurrences occurred following surgical resection. Surgical resection was further categorized based on Enneking appropriateness. Recurrences only occurred following intralesional Enneking inappropriate (EI) resections (P = 0.10), a classification that characterized 47% of all surgical resections. Furthermore, 56% of intralesional resections were EI, compared to only 10% of en bloc resections (P = 0.01). Although SAE treatment did not result in any local recurrences, 35% involved more than five embolization procedures. Spinal ABCs can be effectively treated with intralesional resection, en bloc resection, or SAE. Preoperative embolization should be considered before intralesional resection to limit intraoperative bleeding. Treatment plans must be guided by lesion characteristics and clinical presentation.

Health-Related Quality of Life After Spine Surgery for Primary Bone Tumour

“…For benign aggressive tumours, recommendations in favour of en bloc resection have been made for giant cell tumour and grade 3 osteoblastoma [21]. Treatment of aneurysmal bone cyst can either be en bloc resection or complete intralesional resection [21,22]. Less invasive treatment options, including chemotherapy, interventional radiology and image-guided radiation therapy, are being studied and may change the treatment paradigm for these tumours.…”

Denosumab in patients with aneurysmal bone cysts: A case series with preliminary results

“…In case of spinal localization, neurologic deficit may be caused by infiltration and compression of nerve roots. 4 , 6 - 10 ABCs can occur as a primary tumor in about 70% of cases or as a secondary tumor in 30% of cases; the latter can be associated with osteoblastoma, giant cell tumor of bone (GCTB), chondroblastoma, fibrous dysplasia, or low-grade osteosarcoma. 1 - 4 Historically, the etiology of the lesion was attributed to an increase of venous vascular pressure in the bone, resulting in dilation of small vessels that lead to reabsorption of the matrix.…”

“… 2 Biopsy is mandatory to exclude telangiectatic osteosarcoma 2 , 16 and differential diagnoses with other lesions characterized by the presence of osteoclastic giant cells: giant cell tumor, brown tumor, and nonossifying fibroma. 5 Treatment options for ABCs are represented by surgical resection or curettage, with bone graft or cement usually used to fill the defect, 1 , 2 , 6 , 7 , 17 , 18 selective arterial embolization, 2 , 6 , 8 , 9 , 19 sclerotherapy, 2 , 20 - 22 or radiotherapy. 23 However, all these therapeutic options are burdened with complications 2 , 4 , 10 , 15 , 23 and innovative therapies are needed to treat ABCs.…”

Successful Treatment of a Musculoskeletal Tumor Society Grade 3 Aneurysmal Bone Cyst with N-Butyl Cyanoacrylate Embolization and Percutaneous Cryoablation

“…Surgical resection is necessary when embolization is not technically possible (4). En bloc resection is preferred because recurrence is common in subtotal resection (6)(7)(8). Radiation therapy is a useful adjunct but has also been shown to be associated with an increased risk of axial deformity (4).…”