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

  • Ravish Shammi Patel
  • Chetan Anil Dhamne
  • Anil Gopinathan
  • Nishant Kumar
  • Naresh Kumar
Case Report



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.


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.


Spine Atlas Aneurysmal bone cyst Denosumab Methylprednisolone and calcitonin injection 


Compliance with ethical standards

Conflict of interest

None of the authors has any potential conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, National University HospitalUniversity Orthopaedics, Hand and Reconstructive Microsurgery ClusterSingaporeSingapore
  2. 2.Department of Paediatric Haematology and OncologyNational University HospitalSingaporeSingapore
  3. 3.Department of Diagnostic ImagingNational University HospitalSingaporeSingapore

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