Primary Aneurysmal Bone Cyst of the Spine in Children: Updated Outcomes of a Modern Surgical Technique

Patient 25, an 11-y-old male, presenting with an extensive aneurysmal bone cyst (measuring 4.6× 5.2 × 5.3 mm) involving the posterior elements of L3–L5 and the vertebral body of L4 with almost complete vertebral body obliteration and collapse. Patient had radicular pain on the left lower extremity at presentation. (A) Initially, patient underwent a 4-step approach and stabilization with a sublaminar L3–L5 cable via a posterior approach; however, 8 mo after the index procedure, he presented with significantly increased pain and radiographic evidence of recurrence. (B) Patient underwent a repeat 4-step approach and L2–L5 instrumentation with pedicle screws. At latest follow-up, patient was asymptomatic clinically, had evidence of residual but stable disease, and is currently being closely followed with repeat imaging. (C) Axial and sagittal magnetic resonance imaging cuts depicting the progression of the lesion from preoperative (far left) to recurrence (middle) to latest postoperative (far right) status after repeat 4-step approach. Note the interval size increase and collapse of the L4 vertebral body at the time of recurrence.