Doxycycline sclerotherapy of cervical spine aneurysmal bone cysts: single-institution 13-year experience

Abstract

Background Aneurysmal bone cysts (ABCs) are benign, locally aggressive neoplasms that typically affect patients during their first two decades of life. Curettage with or without bone grafting or adjuvants is the current standard treatment; however, other surgical and medical treatments, such as sclerotherapy, have been reported. Treatment options for cervical spine ABCs are more limited because the proximity of ABCs to critical structures leads to greater risk of spontaneous or treatment-related adverse events, including death. Objective To retrospectively review all children and young adults with cervical spine ABCs treated with doxycycline sclerotherapy at one referral center to assess its viability as a standalone treatment. Materials and methods We retrospectively reviewed the clinical notes and imaging of 16 patients treated with doxycycline sclerotherapy for pathologically proven cervical spine ABCs at our institution between May 2008 and March 2021. All patients underwent image-guided percutaneous doxycycline sclerotherapy to ablate the ABC and stimulate bone formation. We assessed clinical outcomes through chart review and described post-treatment imaging outcomes using modified Neer scoring. Results Of the 16 total children and young adults treated, 2 were lost to follow-up, leaving 14 patients with a median age of 14.5 years. Twelve of these 14 patients were successfully treated with doxycycline sclerotherapy for a success rate of 86%. One patient experienced one treatment-related complication (Society of Interventional Radiology [SIR] adverse event classification D), before ultimately being successfully treated. Doxycycline treatment failed in two patients, who then underwent surgical management. Post-treatment imaging of successfully treated cases had a mean modified Neer score of 1.3, whereas post-treatment imaging in failed cases had a mean score of 3.5. Conclusion Doxycycline sclerotherapy is a viable standalone treatment for cervical spine ABCs because it is safe and effective while avoiding the morbidity associated with open surgical treatments.

Skull base chondroblastoma with aneurysmal bone cyst–like changes treated with percutaneous radiofrequency ablation and doxycycline sclerotherapy: illustrative case

“…This approach was further analyzed in a recent study of 16 patients with cervical spine ABCs. 12 This paper reports that 86% of the patients were cured of their disease after percutaneous sclerotherapy with long-term follow-up, demonstrating that this technique is applicable in even anatomically challenging locations.…”

“… 4 , 5 Percutaneous doxycycline sclerotherapy has been used to treat ABCs with proven safety and efficacy. 11 , 12 Shiels et al 11 successfully treated 21 ABCs with a low recurrence rate of 5%. This approach was further analyzed in a recent study of 16 patients with cervical spine ABCs.…”

“…Radiation therapy and denosumab are usually reserved for ABCs untreatable by direct local therapies such as surgery or sclerotherapy. 12 To avoid the potential for significant morbidity associated with open resection and reconstruction, the patient was referred for percutaneous biopsy and doxycycline sclerotherapy. All procedures were performed after a full discussion of the risks, benefits, and treatment alternatives.…”

“…As is our routine practice when treating an ABC, during that same procedure, doxycycline was injected into the cystic areas under CT guidance using a double-needle technique previously described. 12 Doxycycline (40 mg/mL in normal saline) was mixed 50:50 with 25% human serum albumin (Grifols Therapeutics) and then agitated with an equal volume of air to generate a stable foam with a final doxycycline concentration of 10 mg/mL.…”

“…9 Within the last decade, percutaneous image-guided radiofrequency ablation (RFA) of CBs and doxycycline sclerotherapy of ABCs have proved to be safe and effective alternatives to open resection. [10][11][12][13] Percutaneous minimally invasive treatments can decrease procedural morbidity associated with more extensive open operative approaches. 6,[9][10][11][12] The purpose of this case report is to present a difficult skull base CB with ABC-like changes managed with a combination of RFA and doxycycline sclerotherapy.…”