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Two cases of paralysis secondary to aneurysmal bone cysts with complete neurologic recovery

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Abstract

Design

Case report (retrospective).

Objective

These two cases of paralysis secondary to aneurysmal bone cysts (ABCs) demonstrated complete neurologic recovery following decompression and posterior spinal fusion.

Summary of background data

Although neurologic injury from ABCs has been described, information about the prognosis in the pediatric population is limited.

Methods

We review two cases of paralysis caused by ABCs in the thoracic spine in pediatric patients.

Results

Two patients (aged 12 and 13 years) presented to our emergency department with inability to ambulate and 0/5 strength in their lower extremities due to spinal cord compression from ABCs in their thoracic spine. Both patients had been unable to ambulate (case 1: nonambulatory for 2 weeks before presentation; case 2: nonambulatory for 1 week before presentation). The second patient also had loss of bowel and bladder control. They were managed with decompression and posterior spinal fusion. Both patients made complete neurologic recoveries.

Conclusions

It is unclear whether age, chronicity of compression, or other factors contributed; nevertheless, the recovery in these two similar patients far exceeded initial expectations, especially in the case that presented as an American Spinal Injury Association Impairment Scale class A.

Level of evidence

Level V.

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Fig. 1

Reproduced with permission from the Children’s Orthopaedic Center, Los Angeles

Fig. 2

Reproduced with permission from the Children’s Orthopaedic Center, Los Angeles

Fig. 3

Reproduced with permission from the Children’s Orthopaedic Center, Los Angeles

Fig. 4

Reproduced with permission from the Children’s Orthopaedic Center, Los Angeles

Fig. 5

Reproduced with permission from the Children’s Orthopaedic Center, Los Angeles

Fig. 6

Reproduced with permission from the Children’s Orthopaedic Center, Los Angeles

Fig. 7

Reproduced with permission from the Children’s Orthopaedic Center, Los Angeles

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Funding

None of the authors received financial support for this study.

Author information

Correspondence to David L. Skaggs.

Ethics declarations

Conflict of interest

AB (none), DLS (grants from Pediatric Orthopaedic Society of North America [POSNA] and Scoliosis Research Society [SRS, paid to Columbia University]; Ellipse [co–principal investigator, paid to Growing Spine Foundation (GSF)]; personal fees from Zimmer Biomet, Medtronic, Zipline Medical, Inc., Orthobullets, Grand Rounds [A Healthcare Navigation Company], and Green Sun Medical; other from Zipline Medical, Inc, Green Sun Medical, and Orthobullets; nonfinancial support from Growing Spine Study Group, SRS, and GSF; personal fees from Zimmer Biomet, Medtronic, and Johnson & Johnson; other from Medtronic, Zimmer Biomet, Wolters Kluwer Health–Lippincott Williams & Wilkins, Biomet Spine, and Orthobullets [co–editor in chief], outside the submitted work), TK (none), EK (other from Pfizer, outside the submitted work), LA (personal fees from Biomet, Zimmer, Medtronic, NuVasive; other from Eli Lilly and Journal of Pediatric Orthopedics; personal fees from Orthobullets; other from POSNA and SRS, outside the submitted work).

Ethical approval

This study has been carried out with approval from the Institutional Review Board at Children’s Hospital Los Angeles.

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Beck, A., Skaggs, D.L., Kovach, T. et al. Two cases of paralysis secondary to aneurysmal bone cysts with complete neurologic recovery. Spine Deform (2020). https://doi.org/10.1007/s43390-019-00023-1

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Keywords

  • Aneurysmal bone cyst
  • Compressive neuropathy
  • Paraplegia
  • Cauda equina syndrome
  • Pediatric spine
  • Urgent decompression
  • Instrumentation
  • Spinal tumors
  • Pathologic spinal canal compromise
  • Complete neurological recovery