ANEURYSMAL BONE-CYST OF THE SPINE - MANAGEMENT AND OUTCOME

Study Design. The clinical records, radiographs, histologic sections, and operative reports of 52 consecutive patients with an aneurysmal bo ne cyst of the spine were reviewed to evaluate diagnostic and therapeu tic options and to correlate treatment and outcome. Objectives. To def ine the incidence, clinical presentation, diagnostic and therapeutic o ptions, and prognosis of patients with aneurysmal bone cyst of the spi ne. Summary of Background Data. There are special considerations in th e management of spinal lesions: relative inaccessibility of the lesion s, associated intraoperative bleeding, necessity of removing the entir e lesion to avoid the possibility of recurrence, proximity of the lesi on to the spinal cord and nerve roots, and potential postoperative bon y spinal instability. Methods. Fifty-two consecutive patients with an aneurysmal bone cyst of the spine were treated from 1910 to 1993. Fort y patients initially treated for a primary lesion had operative treatm ent (19 intralesional excision and bone grafting and 21 intralesional excision); four also had adjuvant radiation therapy. Preoperative arte rial embolization was performed in two. Results. There was a recurrenc e rate of 10% within 10 years. All recurrences were noted less than 6 months after surgery. Of 12 patients treated for a recurrent lesion, h ive had a subsequent recurrence (16.7%) within 9 years. At last follow -up examination, 50 patients (96%) were free of the disease. One patie nt died of postradiation osteosarcoma, and one died of intraoperative breeding. Conclusions. Current treatment recommendations involve preop erative selective arterial embolization, intralesional excision curett age, bone grafting, and fusion of the affected area if instability is present.