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Denosumab: a potential treatment option for aneurysmal bone cyst of the atlas

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Abstract

Purpose

Aneurysmal bone cysts (ABCs) of spine are conventionally treated with en-bloc resection or intralesional excision/curettage and reconstruction or filling of defects with bone cement. For the treatment of upper cervical ABCs, en-bloc resections are often not desirable considering the risk/benefit ratio while the risk of recurrence after intralesional excision is high. Hence, alternative management options are often necessary. We describe our clinical experience with one such treatment alternative-denosumab for the treatment of ABC of Atlas.

Methods and results

We present a case of 16-year-old boy who presented with neck pain and restriction of neck movements. A large lytic lesion with multiple fluid–fluid interfaces involving vertebral arch of atlas was identified on further imaging. There was destruction of right lateral mass and the lesion was found encasing the right vertebral artery. Core needle biopsy confirmed the diagnosis of ABC. With no visible CT response after first session of intra-lesional injection of Calcitonin and Methylprednisolone, the patient was treated with denosumab (120 mg SC once-a-month) for a period of 12 months. His symptoms resolved within 7 months of onset of treatment and serial CT scans over 12-month treatment period showed complete ossification of the lesion. Further there was no evidence of recurrence at 12 months after completion of treatment.

Conclusion

Our case report contributes to the accruing evidence on the effectiveness of denosumab for the treatment of spinal ABCs. However, long-term safety, risk of recurrence, optimal duration of treatment and consistency of denosumab are yet to be determined.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, National University Hospital, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore

    Ravish Shammi Patel, Nishant Kumar & Naresh Kumar

  2. Department of Paediatric Haematology and Oncology, National University Hospital, Singapore, Singapore

    Chetan Anil Dhamne

  3. Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore

    Anil Gopinathan

Authors
  1. Ravish Shammi Patel
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  2. Chetan Anil Dhamne
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  3. Anil Gopinathan
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  4. Nishant Kumar
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  5. Naresh Kumar
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Correspondence to Naresh Kumar.

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Patel, R.S., Dhamne, C.A., Gopinathan, A. et al. Denosumab: a potential treatment option for aneurysmal bone cyst of the atlas. Eur Spine J 27 (Suppl 3), 494–500 (2018). https://doi.org/10.1007/s00586-018-5528-x

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  • DOI: https://doi.org/10.1007/s00586-018-5528-x

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