Spinal Aneurysmal Bone Cysts (ABCs): Optimal Management
Received 28 September 2019
Accepted for publication 15 October 2019
Published 24 October 2019 Volume 2019:11 Pages 159—166
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Professor Clark Hung
Jack Parker,1 Sherry Soltani,2 Louis Boissiere,3 Ibrahim Obeid,3 Olivier Gille,3 David Christopher Kieser1
1Department of Orthopaedic Surgery and Musculoskeletal Medicine, Canterbury School of Medicine, University of Otago, Christchurch, New Zealand; 2Division of Spinal Surgery, Oxford University NHS Foundation Trust, Oxford, UK; 3L’Institut de la Colonne Vertébrale, Bordeaux 33076, France
Correspondence: David Christopher Kieser
Department of Orthopaedic Surgery and Musculoskeletal Medicine, Canterbury School of Medicine, University of Otago, 2 Riccarton Avenue, Christchurch 8011, New Zealand
Tel +64 21 149 9829
Aim: To review the published literature on the treatment of aneurysmal bone cysts (ABCs).
Method: A systematic review of the English literature to April 2019 for all articles, with a minimum of three patients and 2-year follow-up, reporting on the treatment of spinal ABCs. The various treatment options were compared for the rates of recurrence, complications and mortality.
Results: Twenty-one articles and 272 patients (mean age 16.9 years, range 3–67) were included in this review. The overall recurrence rate for ABCs following all treatments is 12.8%. This is highest in those lesions described as being treated with isolated surgiflo injection into the lesion (100%), decompression/laminectomy (42.3%), partial excision/resection (35.7%) and curettage alone (25.0%). Radiotherapy alone or in conjunction with operative intervention offers excellent cure rates. Adjuncts to operative intervention, including cryotherapy or phenol reduce the recurrence rates, whereas embolization does not. The most common complications are persistent neurological deficits, spinal deformity, and continued pain. The overall mortality rates are low (1.5%). The reoperation rates are higher in surgical than non-surgical treatments and most are performed for progressive deformity.
Discussion: ABCs are highly radiosensitive. However, with the unknown longer-term risk of radiotherapy, surgical treatments, ideally with complete resection, and the use of adjunctive therapies such as cryotherapy or phenol, offer the best chance of cure. SAE is a useful adjunct to reduce intraoperative bleeding, but this study suggests that it only modestly improves recurrence rates. Newer techniques including bisphosphonate and doxycycline administration offer potential benefits, but their efficacy requires further investigation.
Keywords: spine, tumour, review, aneurysmal bone cyst, ABC
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