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Aneurysmal bone cysts of the spine: treatment options and considerations

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Abstract

Aneurysmal bone cysts (ABCs) are benign bone lesions with annual incidences ranging from 1.4 to 3.2 cases per million people. Approximately, 10–30 % of ABCs are found in the spine. Such lesions are traditionally treated with curettage or other intralesional techniques. Because ABCs can be locally aggressive, intralesional resection can be incomplete and result in recurrence. This has led to increased use of novel techniques, including selective arterial embolization (SAE). This study aims to: (1) compare outcomes based on extent of surgical resection, and (2) compare the efficacy of SAE versus surgical resection. Clinical data pertaining to 71 cases of spinal ABCs were ambispectively collected from nine institutions in Europe, North America, and Australia. Twenty-two spinal ABCs were treated with surgery, 32 received preoperative embolization and surgery, and 17 were treated with SAE. Most tumors were classified as Enneking stage 2 (n = 29, 41 %) and stage 3 (n = 29, 41 %). Local recurrence and survival were investigated and a significant difference was not observed between treatment groups. However, all three local recurrences occurred following surgical resection. Surgical resection was further categorized based on Enneking appropriateness. Recurrences only occurred following intralesional Enneking inappropriate (EI) resections (P = 0.10), a classification that characterized 47 % of all surgical resections. Furthermore, 56 % of intralesional resections were EI, compared to only 10 % of en bloc resections (P = 0.01). Although SAE treatment did not result in any local recurrences, 35 % involved more than five embolization procedures. Spinal ABCs can be effectively treated with intralesional resection, en bloc resection, or SAE. Preoperative embolization should be considered before intralesional resection to limit intraoperative bleeding. Treatment plans must be guided by lesion characteristics and clinical presentation.

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Acknowledgments

We are grateful to the collaborating centers’ local clinical research personnel and support staff for their active participation. This study was organized and funded by AOSpine International, through the AOSpine Knowledge Forum Tumor, a pathology-focused working group of up to ten international spine experts acting on behalf of AOSpine in the domain of scientific expertise. Study support was provided directly through AOSpine’s Research department and AO’s Clinical Investigation and Documentation unit.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Degenerative and Oncological Spine Surgery, Rizzoli Institute, Bologna, Italy

    Stefano Boriani

  2. Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, USA

    Sheng-fu L. Lo, Varun Puvanesarajah, Patti Zadnik, Mari Groves, Daniel M. Sciubba, Chetan Bettegowda & Ziya L. Gokaslan

  3. Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver Coastal Health, Vancouver, BC, Canada

    Charles G. Fisher

  4. National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary

    Peter P. Varga

  5. Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA

    Laurence D. Rhines

  6. Research Department, AOSpine International, Davos, Switzerland

    Niccole M. Germscheid

  7. Oncologia Ortopedica e Ricostruttiva del Rachide, Istituto Ortopedico Galeazzi, Milan, Italy

    Alessandro Luzzati

  8. Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA

    Dean Chou

  9. Spinal Division, Oxford University Hospital NHS Trust, Oxford, UK

    Jeremy J. Reynolds

  10. Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, QLD, Australia

    Richard P. Williams

Authors
  1. Stefano Boriani
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  2. Sheng-fu L. Lo
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  3. Varun Puvanesarajah
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  4. Charles G. Fisher
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  6. Laurence D. Rhines
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  7. Niccole M. Germscheid
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  8. Alessandro Luzzati
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  9. Dean Chou
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  10. Jeremy J. Reynolds
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  11. Richard P. Williams
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  12. Patti Zadnik
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  13. Mari Groves
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  14. Daniel M. Sciubba
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  15. Chetan Bettegowda
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  16. Ziya L. Gokaslan
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AOSpine Knowledge Forum Tumor

Corresponding author

Correspondence to Chetan Bettegowda.

Additional information

Stefano Boriani and Sheng-fu L. Lo are Co-first authors.

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Boriani, S., Lo, Sf.L., Puvanesarajah, V. et al. Aneurysmal bone cysts of the spine: treatment options and considerations. J Neurooncol 120, 171–178 (2014). https://doi.org/10.1007/s11060-014-1540-0

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  • DOI: https://doi.org/10.1007/s11060-014-1540-0

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