Spinal aneurysmal bone cysts in children - institutional chart review and recommendation for treatment.
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Aneurysmal bone cysts (ABC) are benign but locally aggressive tumour like lesions within the bone, affecting younger individuals, representing 1.4% of primary bone tumours with a spinal manifestation in approximately 10–30%. Despite a large variety of therapeutic strategies local recurrence is a well-known problem. The aim of this study is to present our experience and treatment options in children suffering from spinal ABC with special emphasis on complications and recurrence. This is a retrospective chart review based on data extracted from our clinical data bank. We documented age, gender, region of ABC, type of surgery, recurrence, time to recurrence, and follow up time. All patients were treated surgically following the concept of complete tumour removal whenever possible. Spinal reconstruction was performed by 360° fixation using bone filled Harms TSM cage and posterior instrumentation. Statistics were done by an independent co-worker using the current version of SPSS. Chi square tests were used and significance was assumed for p < 0.05. 26 patients treated from 1986 to 2022, 16 females, 10 males, mean age 11 years (range 4–18), lesion at the CCJ/ C- spine in 15, thoracic in 5, lumbar in 6. Surgery: en- bloc spondylectomy in 10, combined anterior – posterior or posterior- anterior surgery with the intent of complete tumour resection in 16 patients. All stabilized by 360° fixation using bone graft/ TSM and posterior instrumentation. Completely uneventful postop course in 16 (61%) patients. Recurrence of the lesion in 5 patients (19%), all recurrences within the cervical spine or CCJ (p = 0.046, φ = 0.44). At the final follow-up, every patient with a treated recurrence had no evidence of further disease. Localization of the ABC at the CCJ/ cervical spine was seen to be a risk factor for early recurrence of the lesion in this cohort. Close follow-up examinations especially within the first year after surgery using contrast enhanced MRI should be performed in paediatric patients with ABC especially if the lesion was located within the cervical spine or CCJ.