238. Management Of Pediatric Spinal Aneurysmal Bone Cysts And Recurrence Outcomes: An Institutional Experience.

Authors: Victor M. Lu, MD; Kendall Snyder, MD; Edward Ahn, MD; David Daniels, MD, PhD (Rochester, MN)

Introduction:

The clinical management and outcomes of rare pediatric spinal aneurysmal bone cysts (spABC) remain poorly defined, as too does their propensity to recur. Correspondingly, the aim of this study was to describe the clinical course of all pediatric spABC cases managed at our institution to better understand this diagnosis.

Methods:

A retrospective cohort study of all pediatric spABC cases presenting to our institution between 1993-2017 was performed using a predetermined set of selection criteria. Primary outcomes of interest were treatment modalities and their outcomes, recurrence status and functional status. 

Results:

A total of 24 pediatric spABC cases satisfied all criteria. Median age of diagnosis was 13.5 years, with 15 females and 9 males. Radicular pain was the presenting symptom in 21 (88%) cases. Diagnostic biopsy was pursued in 9 (38%) cases, pre-operative embolization in 8 (33%) cases, surgical intervention in 23 (96%) cases, and sclerotherapy in 2 (8%) cases. In terms of surgery, there were no intraoperative complications, and gross total resection (GTR) was achieved in 14 of the 23 (61%) cases. Overall, there were 5 (21%) cases which experienced recurrence by a median time of 8 months after initial surgery, all of which had initial subtotal resection. Median follow-up was 5 years, by which all patients demonstrated excellent functional status.

Conclusion:

There are a number of feasible therapeutic modalities and combinations that can be utilized to maximize control of pediatric spABC and optimize long-term function. The incidence of recurrence is not negligible, and therefore rigorous long-term surveillance is highly encouraged, particularly within the first post-operative year following mono-modal non-GTR treatment.