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Aneurysmal bone cyst of the mobile spine: the therapeutic role of embolization
Authors:L. Amendola  L. Simonetti  C. E. Simoes  S. Bandiera  F. De Iure  S. Boriani
Affiliation:1. Department of Orthopedics and Traumatology, Spine Surgery, Maggiore Hospital, ‘C. A. Pizzardi’, Largo Nigrisoli 1, 40100, Bologna, Italy
2. Department of Neuroradiology, Bellaria and Maggiore Hospital, Bologna, Italy
3. Department of Orthopedics and Traumatology, Spine Surgery Unit, Hospital Felício Rocho, Belo Horizonte, Brazil
4. Department of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Bologna, Italy
Abstract:

Purpose

Our aim is to define the role of embolization in the treatment of aneurysmal bone cyst of the spine in order to include this option in the decision making process.

Methods

From April 2004 to November 2009, seven patients with primary aneurysmal bone cyst of the mobile spine treated by embolization have been prospectively followed-up. All clinical presentations and imagings were recorded. There are many options of embolic agent and techniques used, but all aim to devascularize the tumor. The therapeutic protocol includes: embolization repeated every 8 weeks until the appearance of radiographic signs of healing. Complications, rate of healing and clinical outcome were analyzed.

Results

The number of embolizations varied from one to a maximum of seven without related intra- or post-operative complications. One patient, after four selective arterial embolizations, underwent direct percutaneous injection of embolic agents into the cyst. A clinical and radiographical response was achieved in all patients who were found alive and completely free of disease at mean follow-up of 46 months after last treatment and nobody crossed to surgical option.

Conclusion

Embolization seems to be the first option for spinal aneurysmal bone cyst treatment because of the best cost-to-benefit ratio. It is indicated in intact aneurysmal bone cyst, when diagnosis is certain, when technically feasible and safe and when no pathologic fracture or neurologic involvements are found. If embolization fails, other options for treatment would still be available.
Keywords:Aneurysmal bone cyst   Primary bone tumor   Mobile spine   Embolization
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