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Feuerstein L, Martens B, Schwizer R, Forster T, Ziga M. Implantation of C2 prosthesis with dorsal fusion C0-C4 due to pathologic C2 fracture. Case report and literature review. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05386-3. [PMID: 38777907 DOI: 10.1007/s00402-024-05386-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Pathological destruction of the axis vertebra leads to a highly unstable condition in an upper cervical spine. As surgical resection and anatomical reconstruction of the second cervical vertebrae represents a life threatening procedure, less radical approaches are preferred and only few cases of C2 prosthesis are described in literature. CASE DESCRIPTION The focus of this case report is a 21-year-old man with a pathological fracture of C2 managed primarily surgically with the C1-C3 dorsal fusion. Due to the progression of giant cell tumor and destruction of the axis vertebra, C2 prosthesis through anterior approach and dorsal occipito-cervical fusion C0-C4 were performed. Postoperative infection was managed surgically with a 2-staged dorsal debridement, ostheosynthesis material change and autologous bone graft. After a 4 week-intravenous therapy with the ceftriaxone in combination with the amoxicillin/clavulanate, followed by 12 week per oral therapy with amoxicillin/clavulanate in combination with ciprofloxacin, the complete recovery of the infection was achieved. Radiotherapy was initiated 2 months after the last revision surgery and the patient showed a good clinical outcome with stable construct at a 1 year follow-up. A review of literature of all reported C2 prosthesis cases was performed CONCLUSION: C2 prosthesis allows a more radical resection in pathological processes involving the axis vertebra. Combined with the posterior fusion, immediate stability is achieved. Anterior surgical approach is through a highly unsterile oral environment which presents a high-risk of postoperative infection.
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Affiliation(s)
- Laurin Feuerstein
- Spine Center of East Switzerland, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Orthopedics and Traumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Benjamin Martens
- Spine Center of East Switzerland, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Orthopedics and Traumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Roman Schwizer
- Spine Center of East Switzerland, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Orthopedics and Traumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Thomas Forster
- Spine Center of East Switzerland, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Michal Ziga
- Spine Center of East Switzerland, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
- Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, St. Gallen, 9001, Switzerland.
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
- Department of Neurosurgery and Spine Surgery, Cantonal Hospital Lucerne and University of Lucerne, Lucerne, Switzerland.
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Gensler R, Roehrkasse A, Dowlati E, Sloan E, McGrail K. Surgical management of a multilevel thoracolumbar aneurysmal bone cyst. BMJ Case Rep 2024; 17:e259708. [PMID: 38684351 PMCID: PMC11146411 DOI: 10.1136/bcr-2024-259708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 05/02/2024] Open
Abstract
Aneurysmal bone cysts (ABCs) are primary bone tumours that rarely occur in the spine and generally affect one vertebral level in adolescents. Here, we present an unusual case of a multilevel thoracolumbar ABC, which presented a unique surgical challenge due to its infiltrative and destructive nature. A teenage male presented with back pain, paresthesias and a mildly spastic gait. MRI of the thoracolumbar spine revealed an expansive, multicystic mass extending from the left T12-L1 vertebral bodies into adjacent musculature. The patient underwent a two-stage surgical approach with decompression of the spinal cord and instrumentation to stabilise the vertebral column. The first stage involved posterior decompression, laminectomy and facetectomies, followed by pedicle-based instrumentation from T10 to L3. This was followed by a vertebrectomy and anterior stabilisation with an expansile cage from T11 to L2. A gross total resection was achieved with the patient maintaining full neurological function.
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Affiliation(s)
- Ryan Gensler
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Amanda Roehrkasse
- Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Ehsan Dowlati
- Neurosurgery, University of Michigan, Michigan, MI, USA
| | - Emily Sloan
- Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Kevin McGrail
- Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
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Abrar WA, Sarmast A, Sarabjit Singh AR, Khursheed N, Ali Z. Aneurysmal Bone Cysts of Spine: An Enigmatic Entity. Neurol India 2020; 68:843-849. [PMID: 32859826 DOI: 10.4103/0028-3886.293465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims The study was done to review the literature about the intriguing aspects of the aneurysmal bone cyst and to describe our experience with these cases. Design Retrospective. Material and Method We reviewed the records of all patients with primary spinal tumours whom we managed over last 8 years. We selected the patients with biopsy proven aneurysmal bone cyst (ABC) for our study. Results Four patients (two males and two females) were included. The age ranged from 15-18 years. Three of them had neurological deficits and one had only pain. All of them were operated and three required instrumentation for stabilization. Neurological deficits improved in all the cases. However we had to re- operate one of the cases for recurrence and that patient was administered adjuvant radiotherapy. Conclusions ABC is not a tumour in real sense but due to destructive nature that are classified as tumours. The patients have an excellent outcome as the disease is benign and has very low recurrence rates if surgical excision is complete. Best treatment modality is complete excision. Aneurysmal bone cyst is one of the uncommon tumors of the spine, and many of its features continue to be unclear even today. There is ambiguity about the definition, etiopathogenesis, radiological characteristics, histopathology and treatment modalities. They are common in young age and etiology is not clear. The presentation is varied with pain being the common symptom and neurological deficit depends on extent of cord involvement. The best treatment is controversial although surgery is believed to be curative in the majority of cases. We here describe our experience with four such cases who had varied clinical presentation and outcome.
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Affiliation(s)
- Wani Ahad Abrar
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Arif Sarmast
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Altaf Ramzan Sarabjit Singh
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Nayil Khursheed
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Zulfiqar Ali
- Department of Anesthesiology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Shkarubo AN, Kuleshov AA, Chernov IV, Vetrile MS, Berchenko GN, Lisyanskiy IN, Makarov SN. [Anterior stabilization of the CI-CIII vertebrae after transoral removal of an aggressive aneurysmal bone cyst of the CII vertebra (a case report and literature review)]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 82:111-118. [PMID: 30412164 DOI: 10.17116/neiro201882051111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Treatment of patients with atlantoaxial instability caused by various diseases of the skull base and craniovertebral junction combined with ventral compression of the brainstem is a complex issue that is ambiguously resolved in different ways. We present a case of stepped treatment, the most important component of which was successful transoral removal of an aggressive aneurysmal bone cyst of the CII vertebra with anterior CI-CIII segment stabilization using an individual system, which was performed through the same approach. CLINICAL CASE A 31-year-old male patient presented with destruction of the CII body and odontoid process affected by an aggressive aneurysmal bone cyst causing disintegration of the CII posterior wall and odontoid process, which clinically manifested by constricted motion and pain in the cervical spine. RESULTS Three-step surgical treatment was performed. First, we performed a puncture biopsy of the CII body through the submandibular approach as well as posterior occipitospondylodesis with metal instrumentation from the occipital bone level to the CIV vertebra. Two months later, the patient underwent transoral removal of the CII body and odontoid process lesion and anterior CI-CIII segment stabilization using an individual cover metal system through the same approach. Two weeks after the second intervention, the occipitospondylodesis was transformed to a posterior CI-CIII stabilization system. Control CT 8 months after surgery showed the correct position of both stabilization systems. CONCLUSION The use of individual instrumentation for anterior stabilization of the CI-CIII vertebrae in various diseases of the craniovertebral junction area is an effective and promising technique.
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Affiliation(s)
- A N Shkarubo
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A A Kuleshov
- Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia
| | - I V Chernov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - M S Vetrile
- Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia
| | - G N Berchenko
- Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia
| | - I N Lisyanskiy
- Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia
| | - S N Makarov
- Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia
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Early Recurrence of a Solid Variant of Aneurysmal Bone Cyst in a Young Child After Resection: Technique and Literature Review and Two-year Follow-up After Corpectomy. J Am Acad Orthop Surg 2018; 26:369-375. [PMID: 29642082 DOI: 10.5435/jaaos-d-16-00315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Aneurysmal bone cysts (ABCs) are considered to be rare benign tumors that may affect long bones or the vertebral column. Their incidence varies and is reported to be 1.4% of all benign skeletal tumors. The solid-variant aneurysmal bone cyst (S-ABC) is even rarer and constitutes 3.5% to 7% of all vertebral ABCs. We report the case of an Enneking stage 3 S-ABC in a 5-year-old boy at C7 that showed rapid local recurrence after primary excision from posterior and dorsal stabilization requiring ventral corpectomy and posterior excision of the right lateral mass and right posterolateral fusion. Histologic examination disclosed an S-ABC. To our knowledge, this is the first case of S-ABC described in the literature that used both anterior and posterior approaches and complete corpectomy. Over a 2-year period, the patient showed no radiologic or clinical signs of local recurrence with excellent neurologic function. Solid-variant aneurysmal bone cysts are difficult to diagnose and treat, and careful clinical and radiologic assessment should be done to tailor an appropriate surgical plan to prevent recurrence and neurologic sequelae. To the best of our knowledge, there are to date no publications that studied the behavior of this subtype.
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Shkarubo AN, Kuleshov AA, Chernov IV, Vetrile MS, Lisyansky IN, Makarov SN, Ponomarenko GP, Spyrou M. Transoral Decompression and Stabilization of the Upper Cervical Segments of the Spine Using Custom-Made Implants in Various Pathologic Conditions of the Craniovertebral Junction. World Neurosurg 2018; 109:e155-e163. [DOI: 10.1016/j.wneu.2017.09.124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 02/09/2023]
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Brage L, Roldán H, Plata-Bello J, Martel D, García-Marín V. Transoral vertebroplasty for a C2 aneurysmal bone cyst. Spine J 2016; 16:e473-7. [PMID: 26961198 DOI: 10.1016/j.spinee.2016.02.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 01/28/2016] [Accepted: 02/23/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Aneurysmal bone cysts at the cervical spine represent a real challenge both diagnostically and therapeutically, especially in young patients. PURPOSE We present an unusual case of a C2 aneurysmal bone cyst expanding in the entire vertebral body in a girl successfully treated with a transoral vertebroplasty. STUDY DESIGN This is a case report study. METHODS We report the case of a 17-year-old girl with a history of cervical pain and occipital headache after a car accident. Routine x-rays disclosed a C2 lesion. Her neurologic examination was normal. Computed tomography showed a lytic lesion occupying almost the entire body of the C2 vertebra. The cortical bone was intact but notably thinned. Magnetic resonance imaging revealed a cystic image with blood inside. Transoral vertebroplasty was selected among other surgical options for the following reasons: (1) to improve the clinical symptoms, and (2) to prevent future vertebral collapse with devastating neurologic consequences. Under general anesthesia and continuous neurophysiological monitoring, we conducted a fluoroscopic-guided transoral vertebroplasty through a Jamshidi needle. A cytology sample from the cystic lesion was taken through the needle. RESULTS The blood smear showed no tumoral cellularity. There were no complications during surgery or postoperative infections. After 4 years of follow-up, the patient is pain-free and leads a normal life. CONCLUSIONS Transoral vertebroplasty seems to be a direct, safe, and effective technique to stabilize cystic lesions that endanger the stability of C2 and to improve symptoms. Aneurysmal bone cysts should be included in the differential diagnosis of lytic lesions at the C2 vertebral body.
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Affiliation(s)
- Liberto Brage
- Department of Neurosurgery, Hospital Universitario de Canarias, Carretera Ofra s/n La Cuesta. CP 38320. La Laguna, S/C de Tenerife, Spain
| | - Héctor Roldán
- Department of Neurosurgery, Hospital Universitario de Canarias, Carretera Ofra s/n La Cuesta. CP 38320. La Laguna, S/C de Tenerife, Spain
| | - Julio Plata-Bello
- Department of Neurosurgery, Hospital Universitario de Canarias, Carretera Ofra s/n La Cuesta. CP 38320. La Laguna, S/C de Tenerife, Spain.
| | - Diego Martel
- Department of Neurosurgery, Hospital Universitario de Canarias, Carretera Ofra s/n La Cuesta. CP 38320. La Laguna, S/C de Tenerife, Spain
| | - Víctor García-Marín
- Department of Neurosurgery, Hospital Universitario de Canarias, Carretera Ofra s/n La Cuesta. CP 38320. La Laguna, S/C de Tenerife, Spain
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Li Q, Fu Y, Dong Y, Zeng B, Zhang C. Fibrohistiocytoma combined with an aneurysmal bone cyst at T7 in a 63-year-old woman. Exp Ther Med 2013; 6:1127-1130. [PMID: 24223633 PMCID: PMC3820729 DOI: 10.3892/etm.2013.1272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 08/19/2013] [Indexed: 11/30/2022] Open
Abstract
We present a case of spinal tumor, with fibrohistiocytoma combined with aneurysmal bone cyst (ABC) at the pedicle and transverse process of T7 in a 63-year-old female. ABC is a rare skeletal tumor and spinal ABC is extremely rare. Fibrohistiocytoma is a type of primary benign bone tumor. ABC is also a rare bone tumor that most often occurs in the pelvis. The combined lesion of two primary bone benign tumors is relatively rare in clinic. In addition, fibrohistiocytoma and ABC are widely confused with other giant cell containing tumors of the bone. X-rays, magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT) scans were performed and assessed. Finally, the diagnosis was confirmed by pathological tests. The patient underwent surgery and had an extremely good recovery. The correct diagnosis of a spine tumor is important when determining the surgical procedure.
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Affiliation(s)
- Qi Li
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Jiaotong University, Shanghai 200233, P.R. China
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Abstract
PURPOSE To review records of 14 patients with aneurysmal bone cysts (ABCs) of the spine. METHODS Using the Scottish Bone Tumour Registry for the period of October 1952 to November 2005, records of 9 females and 5 males aged 8 to 63 (mean, 25.3) years who had ABCs of the spine and were followed up for a mean of 7.1 years were reviewed. RESULTS The most commonly involved site was the lumbar vertebrae (n=6), followed by the thoracic (n=4), cervical (n=3), and sacral (n=1) vertebrae. The mean duration of symptoms at presentation was 8.8 (range, 0.3-24) months. The symptoms included gradually increasing pain in the back (n=14), a palpable spinal mass (n=4), spinal deformity (n=2), and neurological deficits (n=5). All the patients underwent surgery: intra-lesional excision (curettage) without bone grafting (n=3), excision (n=7, 2 of whom had adjuvant radiotherapy), and open excisional biopsy (n=4, 2 of whom had iliac crest bone grafting). One patient with a cervical ABC underwent preoperative angiographic embolisation. Another patient with a sacral ABC underwent percutaneous sclerotherapy. Two patients had recurrence. One had recurrence within 4 months and underwent adjuvant radiotherapy; another had recurrence 16.8 years later and underwent repeat curettage. No major complications were encountered. CONCLUSION Most ABCs of the spine occurred in young females. Intra-lesional excision was an effective treatment.
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Ropper AE, Cahill KS, Hanna JW, McCarthy EF, Gokaslan ZL, Chi JH. Primary vertebral tumors: a review of epidemiologic, histological, and imaging findings, Part I: benign tumors. Neurosurgery 2012; 69:1171-80. [PMID: 21725252 DOI: 10.1227/neu.0b013e31822b8107] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Primary vertebral tumors, although less common than metastases to the spine, make up a heterogeneous group of neoplasms that can pose diagnostic and treatment challenges. They affect both the adult and the pediatric population and may be benign, locally aggressive, or malignant. An understanding of typical imaging findings will aid in accurate diagnosis and help neurosurgeons appreciate anatomic subtleties that may increase their effective resection. An understanding of the histological similarities and differences between these tumors is imperative for all members of the clinical team caring for these patients. In this first review of 2 parts, we discuss the epidemiological, histological, and imaging features of the most common benign primary vertebral tumors-aneurysmal bone cyst, chondroma and enchondroma, hemangioma, osteoid osteoma, and osteoblastoma-and lesions related to eosinophilic granuloma and fibrous dysplasia. In addition, we discuss the basic management paradigms for each of these diagnoses. In combination with part II of the review, which focuses on locally aggressive and malignant tumors, this article provides a comprehensive review of primary vertebral tumors.
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Affiliation(s)
- Alexander E Ropper
- Department of Neurosurgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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Ramme AJ, Smucker JD. Balancing spinal stability and future mobility in the cervical spine: surgical treatment of a case of osteoblastoma with secondary aneurysmal bone cyst. Spine J 2011; 11:e5-12. [PMID: 21558033 DOI: 10.1016/j.spinee.2011.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 12/27/2010] [Accepted: 03/10/2011] [Indexed: 02/09/2023]
Abstract
BACKGROUND CONTEXT The combination of osteoblastoma and aneurysmal bone cyst (ABC) in the cervical spine is a relatively rare occurrence in the general population. The diagnosis and surgical management of osteoblastoma and ABCs have been previously described in a small number of case reports/series and orthopedic texts. Lesions of the cervical spine pose challenges to surgeons that require preoperative planning and intraoperative decisions to ensure an appropriate patient outcome. Complete resection has been shown to be the most effective method for preventing recurrence; however, balancing spinal stability, future mobility, and complete resection is especially important in active young patients. PURPOSE We describe a modern approach to the surgical management of osteoblastoma with secondary ABC of the cervical spine with 4-year clinical and radiographic follow-up. Included in this report is a comprehensive review of the literature related to osteoblastoma, ABCs, and surgical issues pertinent to them. STUDY DESIGN An independent retrospective case review combined with a review of current literature was performed. PATIENT SAMPLE A single patient with a combination of osteoblastoma and secondary ABC is presented. OUTCOME MEASURES During 4 years of follow-up, the patient has been evaluated with plain radiographs for subluxation or rotation of the cervical spine. Postoperative assessments for pain and range of motion were also collected. METHODS The medical, pathologic, and radiographic records of a case of osteoblastoma with secondary aneursymal bone cyst of the cervical spine were reviewed. A computer-based literature search of the PubMed database was used to compile a comprehensive review of the topic. RESULTS The diagnosis and surgical treatment of osteoblastoma with secondary ABC in the cervical spine are discussed in the context of a literature review. The surgical management of this lesion was dictated by the size and location of the mass as well as the impact of the surgical resection on surrounding structures in terms of spinal stability and future mobility. CONCLUSIONS The combination of osteoblastoma and ABC in the cervical spine is an uncommon occurrence in the general population. In the cervical spine, careful surgical planning and a case-by-case evaluation must be implemented to minimize morbidity and recurrence for every patient.
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Affiliation(s)
- Austin J Ramme
- Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, 200 CMAB, Iowa City, IA 52242, USA
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Tonomura ET, Ramos P, Hemais PM, Marchiori E, Gasparetto EL. Aneurysmal bone cyst at C2: imaging evaluation after intralesional injection of calcitonin and methylprednisolone. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 66:711-5. [PMID: 18949268 DOI: 10.1590/s0004-282x2008000500020] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Accepted: 08/09/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To demonstrate imaging findings during the follow-up of patients with aneurysmal bone cyst (ABC) of C2 treated with intralesional injection of calcitonin and methylprednisolone. METHOD Three patients with ABC of C2 were treated percutaneously with intralesional injection of calcitonin and methylprednisolone. All the patients were females, with ages varying from 6 to 13 years. All of them presented with cervical masses, but without neurological symptoms. RESULTS Imaging follow-up with CT and plain films showed progressive ossification and reduction of the blood-filled cavities with volume reduction of all lesions. No recurrence was noted during the follow-up. CONCLUSION Intralesional injection of calcitonin and methylprednisolone is a safe treatment option for cervical ABC. The CT scan is especially valuable as a guide of injection site and for the follow-up of ossification of the treated ABCs.
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Affiliation(s)
- Elise T Tonomura
- Instituto Nacional de Traumato-Ortopedia, Rio de Janeiro, RJ, Brasil.
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Abstract
STUDY DESIGN Case report. OBJECTIVE To present 2 cases of aneurysmal bone cyst in the cervical spine of children who were aggressively treated with resection, fusion, and stabilization with hardware to achieve complete cure and future stability. SUMMARY OF BACKGROUND DATA Aneurysmal bone cyst is a rapidly expanding and destructive bone lesion of unknown etiology. Current approaches to treatment include surgical en bloc excision, complete curettage, selective arterial embolization, radiotherapy, and intralesional injection with a sclerosing agent. Fusion and stabilization with instrumentation have often been avoided in children due to concerns over instability following future axial skeleton growth. METHODS The authors present 2 case reports of aneurysmal bone cyst in the cervical spine of children, both demonstrating deeply involved lesions with extensive bone destruction. Both were treated aggressively with resection, fusion, and stabilization with instrumentation. Additionally, the relevant background literature is briefly discussed. RESULTS Both patients had an uncomplicated postoperative course. At 36- and 18-month follow-up, both patients have no cervical spine instability or recurrence of tumor. CONCLUSION Treatment of aneurysmal bone cyst in the cervical spine is challenging when it occurs in close proximity to neural and vascular structures. Future stability of the cervical spine is a concern, especially when there is significant involvement of the vertebral body and posterior elements. At 36- and 18-month follow-up, the surgical approach to aneurysmal bone cyst presented here provided these patients with complete curative treatment and preservation of cervical spine stability.
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Jeszenszky D, Fekete TF, Melcher R, Harms J. C2 prosthesis: anterior upper cervical fixation device to reconstruct the second cervical vertebra. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2007; 16:1695-700. [PMID: 17632736 PMCID: PMC2078292 DOI: 10.1007/s00586-007-0435-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2007] [Accepted: 06/24/2007] [Indexed: 01/22/2023]
Abstract
Destruction of the second cervical vertebra leads to a highly unstable situation. Reconstruction is difficult because the axis plays a central role in rotatory movements and has a unique function in redistributing axial loads. The axis transfers the axial load of the two lateral masses of the atlas to three surfaces on the third cervical vertebra: the two articular facets and the vertebral body. As reconstruction is difficult and the instability in this region is life threatening, pathological processes are often treated less radically compared to other areas of the cervical spine. However, this more moderate approach may result in worse outcomes and prognoses. This paper presents the development of a new implant (C2 prosthesis) and two illustrative cases describing the implementation of this new implant. The C2 prosthesis provides anterior support and therefore allows a more radical surgical approach.
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Affiliation(s)
- Dezso Jeszenszky
- Schulthess Clinic, Spine Center, Lengghalde 2, 8008, Zurich, Switzerland.
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