Surgical resection of a giant spine aneurysmal bone cyst in a child

Abstract

Introduction: Aneurysmal bone cyst is a benign and destructive bone lesion of unknown etiology. Current approaches to treatment include surgical en bloc excision, curettage, selective arterial embolization and radiotherapy. A giant aneurysmal bone cyst in the lumbar vertebra is reported, along with a brief review of the literature on the topic. Method:A 15-yearold boy presents with lumbar pain and a 3 months history of paraparesis. Diagnostic imaging revealed an expansile lytic lesion in the spinous process and lamina of the fourth and fifth lumbar vertebra. Surgical treatment consisted of excisional biopsy and a segmental instrumented posterior fusion from L2-S1. Histopathology was consistent with an aneurysmal bone cyst. After one year, the patient improved his neurological function with only a L5 bilateral paresis. Discussion: Treatment of aneurysmal bone cysts of the spine is challenging when it occurs in close proximity to neural and vascular structures. Fusion and stabilization with instrumentation are often necessary. One vertebra is involved in most cases and extensive lesions are uncommon. Complete tumor resection and fusion of lumbar spine, using stabilization with instrumentation provide both cure and preservation of lumbar spine stability. Neurological deficits can be improved by surgical removal of the tumor