1476. Analysis of Surgical Outcome in Aneurysmal Bone Cysts of Spine

Authors: Dibya Jyoti Mahakul; RAMESH DODDAMANI, MCh; RAJESH MEENA, MCh; DEEPAK AGRAWAL, MCh (New Delhi, India)

Introduction:

Aneurysmal bone cysts are relatively rare, vascular, and osteolytic  lesions of unknown etiology, comprising merely 1.4% of all primary bone tumours. Vertebral column involvement has been reported in merely 3-30% of cases. Although benign, these are locally aggressive and have a high recurrence rate.  In this case series we have described the outcome of 9 patients who underwent surgery for the spinal aneurysmal bone cyst.

Methods:

Between 2014-2018, 9 patients with aneurismal bone cysts of spine underwent surgery at our institute. Clinical records, imaging, operative findings and histopathology record and current neurologic status were analysed to assess the outcome in these patients.

Results:

Mean age of patients in the study group was 20.77 years and 67% were male. Most common site for ABC was cervico-dorsal junction(4 patients), followed by lower dorsal(2 patients). Lesion was  at midline in 7 cases. The median duration of symptoms was 12 months. Axial pain was the most common symptom and the site of clinical localization corresponded to the pathological site on imaging. MRI of all the 9 patients showed fluid-fluid levels, bone edema, canal compromise. However, paravertebral extension was seen in only 2 patients. 5 cases underwent total excision of the lesion, of which 3 had corpectomy during the first surgery. Of the 4 patients who had subtotal excision, 2 had to undergo undergo re-exploration and excision of residual lesion and one had multiple recurrences. 8 patients underwent instrumentatation to restore spinal stability. After a median follow up period of 24 months, 5 showed no evidence of recurrence while 2 patients are still alive residual lesion.

Conclusion:

Management  of ABC is controversial in view of various available treatment modalities. However, total excision of lesion with instrumentation is optimum for treatment of this locally aggressive pathology and prevention of its recurrence.