Therapeutic options to prevent recurrence of an aggressive aneurysmatic bone cyst of the cervical spine of a 16 year old boy - a case report

Abstract

The aneurysmatic bone cyst (ABC) is a benign primary bone tumour. If located in the cervical spine, its expansive growth and destructive behaviour may lead to instability and serious neurological impairment. We report a case of a 16-year-old boy with an aggressive ABC in the 7th cervical vertebra. Computertomographic and magnetic resonance imaging revealed the envelopment of the left 7th and 8th spinal nerve along with the anterior displacement of the left vertebral artery. The interdisciplinary surgical strategy consisted of a partially incomplete cyst resection, subtotal spondylectomy with posterior screw-and-rod fixation from C6-Th1, iliac crest bone grafting and anterior plating from C6-Th1. With regard to the high rate of recurrence after incomplete resection published in the recent literature, the patient was postoperatively treated by megavoltage radiotherapy with a total dose of 30Gy (daily dose of 1.8 Gy for 3 weeks). The clinical and radiographic follow-up showed complete recovery of all neurologic impairments and no signs of tumour recurrence at 3, 6 and 12 months after surgery. This case highlights diverse treatment regimens and shall outline the challenge and the problems of the interdisciplinary decision-making in adolescents presenting with ABC in high-demanding anatomical regions.

Aneurysmal Bone Cyst of the Cervical Spine

“…ABCs are described as benign bone lesions predominantly located in the metaphysis of the long bones and most of them express expansive and destructive growth affecting mainly pediatric population 8 . Cervical spine ABCs, though very rare, represent a great surgical challenge because of the close proximity or involvement of near neurovascular structures [1][2][3] . Predominant predilection place of these lesions are posterior elements of the cervical spine mostly affecting one vertebrae with a great risk of vertebral artery injury 9 although, our case demonstrated both anterior and posterior elements involvement of the two adjacent cervical vertebrae.…”

“…Special care should be taken when using this method in patients with cervical spine aneurysmal lesions because there is a high risk of ischemic spinal cord damage 12 . Regarding incomplete ABC resection, some authors consider radiotherapy as adjuvant therapy to be beneficial for the prophylaxis of tumor recurrence in patients with skeletal growth completion 1 . Additionally, there are evidences in favor of sclerotherapy for treatment of spinal ABCs without compromised neural structures 1,13 .…”

“…Aneurysmal bone cyst (ABC) is a non-neoplastic locally destructive primary bone lesion mostly occurring within the first two decades of life with female predominance. Almost 30% of all ABCs occur in the spine with those in the cervical spine making only about 22% 1 . Studies have shown that the potential mechanism for ABC formation may be associated with primary bone lesion of diverse origin resulting in secondary vascular lesion that causes erosion in the bone with development of osteoblastic and osteoclastic reaction 2 .…”

“…Cervical ABCs treatment options remain controversial with no specific guidelines, mainly depending on institution-based experience. Depending on the case, current treatment options include preferably total surgical removal with or without fusion and preoperative embolization, selective injections of sclerosing agents, radiotherapy and cryotherapy 1,5 . Recurrence rate for ABCs can be up to 30% and it can be reduced by supramarginal resection which is not always achiev-…”