Aneurysmal bone cyst of the spine: 31 cases and the importance of the surgical approach

Thirty-one cases of aneurysmal bone cyst of the spine with a minimum follow -up of 1 year as registered by the Netherlands Committee for Bone Tumors ar e reported. Aneurysmal bone cyst is a benign, sometimes expansive and destr uctive, lesion frequently occurring between the ages of 10 and 20 years. Lo cated in the vertebral column, it undermines the structural integrity of th e spine, and neurologic complications can occur. In all eases the posterior elements were involved, with extension into the vertebral body occurring i n 22 cases. Extension to adjacent vertebra occurred 5 times, but the interv ertebral disc appeared to be left intact. Twenty-nine of 31 cases were trea ted surgically. Posterior approaches provided insufficient access to lesion s also located in the vertebral body and were associated with a higher recu rrence rate (5 of Is cases) than anterior approaches (1 of 11 cases). Of 10 cases in which the surgical removal was incomplete, 4 healed and 6 had a l ocal recurrence. Selective embolization was used twice, and its application is discussed. On the basis of this material and a review of the literature , treatment by intralesional curettage combined by adjuvant therapy such as preoperative embolization is advised.