Validating the management paradigm for pediatric spinal aneurysmal bone cysts to optimize long-term outcomes: an institu
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ORIGINAL ARTICLE
Validating the management paradigm for pediatric spinal aneurysmal bone cysts to optimize long-term outcomes: an institutional experience Victor M. Lu 1 & Kendall A. Snyder 1 & Edward S. Ahn 1 & David J. Daniels 1 Received: 22 August 2019 / Accepted: 27 February 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background The optimal clinical management and outcomes of rare pediatric spinal aneurysmal bone cysts (spABC) is largely anecdotal. Current practice is based on bigger adult series, although given the disparities in spine growth of adults versus children, what impact this difference may have on long-term outcomes has yet to be substantiated. 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. Methods A retrospective cohort study of all pediatric spABC cases presenting to our institution between 1993 and 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, preoperative 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. Conclusions There are a number of feasible therapeutic modalities and combinations that can be utilized to maximize control of pediatric spABCs and optimize long-term function similar to that of adults, irrespective of developing versus developed spines. 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. Keywords Pediatric . Aneurysmal bone cyst . Spine . Cervical . Recurrence . Embolization . Sclerotherapy
Introduction Aneurysmal bone cysts are rare, benign cystic lesions originating from the bone. They constitute 1–6% of all bone tumors and occur in approximately 1.4 people per 100,000 per year [23]. Of these, 10–30% are located in the spine, which make up approximately 10–20% of all spinal tumors [4, 9]. As per the World Health Organization, these spinal aneurysmal * Victor M. Lu [email protected] * David J. Daniels [email protected] 1
Department of Neurologic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
bones cysts (spABCs) are described as expanding
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