Modern Surgical Treatment of Primary Aneurysmal Bone Cyst of the Spine in Children and Adolescents

Purpose: Treating children with spinal aneurismal bone cyst poses special hazards due to close proximity of the lesion to the spinal cord and the necessity to preserve spinal stability and balance following surgery. We present an intra-lesional approach with reduced morbidity and incidence of recurrence similar to extra-lesional resection.

Methods: Twelve children with aneurysmal bone cyst treated between 1990 and 2002 at a tertiary pediatric musculoskeletal tumor center were identified from the musculoskeletal tumor database. Four children had a simple intra-lesional curettage and bone-grafting procedure done by the neurosurgical department while the remaining eight were treated using modern surgical technique with a four-step approach: intra-lesional curettage, high-speed diamond burr, electrocautery, and bone grafting. The ages of the children ranged from 6.6 to 18.6 years of age (mean 12.9 years). All have greater than two years of follow-up (range 2-13.1 years, mean 5.8 years). Lesions occurred throughout the spine; two cervical, four thoracic, four lumbar, and two sacral.

Results: Surgical technique utilizing a four-step approach was found to have a significantly reduced rate of recurrence (0 of 8 cases) compared to traditional intra-lesional curettage and bone grafting (4 of 4 cases) (p<0 .002). Short-segment spinal fusion with instrumentation was also done in five cases immediately following excision of the aneurismal bone-cyst under same anesthesia and a nonsiginificant marker for reduced rate recurrence(p<0.08); likely secondary to wide exposure. There were no surgical complications. At last follow-up, all twelve patients are alive well evidence disease, neurologic symptoms, significant deformity.

Conclusions: The four-step approach utilized in this series is less morbid than extra-lesional or en bloc resection while still maintaining excellent long-term results in terms of prevention of recurrence and long-term spinal deformity.