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Research ArticleTumor

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

EMMANOUIL GRIGORIOU, JOHN P. DORMANS and ALEXANDRE ARKADER
International Journal of Spine Surgery August 2020, 14 (4) 615-622; DOI: https://doi.org/10.14444/7082
EMMANOUIL GRIGORIOU
1Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
3Department of Orthopaedic Surgery, University at Buffalo, Buffalo, New York
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JOHN P. DORMANS
2Department of Orthopaedic Surgery, Riley Children's Hospital, Indianapolis, Indiana
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ALEXANDRE ARKADER
1Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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    Figure 1

    Patient 14, 9-y-old male, presenting with right lower extremity radicular-type pain and an L4 vertebral body aneurysmal bone cyst measuring 2.2 × 4.7 × 4 mm. (A) Preoperative axial, coronal, and sagittal computed tomography showing the expanding L4 vertebral body lesion with extension to and obliteration of the right pedicle. (B) Patient underwent a 4-step approach, L3–L5 instrumentation, and L4 vertebral cage. Patient was asymptomatic without clinical or radiographic evidence of recurrence at latest follow-up 8 y later at 17 y old.

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    Figure 2

    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.

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    Figure 3

    Patient 11. Preoperative lateral radiograph (A), axial computed tomography (B), intraoperative picture (C), and postoperative lateral and anteroposterior radiographs (D). This 16-y-old female presented with an expanding L4 aneurysmal bone cyst limited to the posterior elements and underwent a 4-step approach and subsequent L3–L5 instrumentation with a hook and rod construct.

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International Journal of Spine Surgery
Vol. 14, Issue 4
1 Aug 2020
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Primary Aneurysmal Bone Cyst of the Spine in Children: Updated Outcomes of a Modern Surgical Technique
EMMANOUIL GRIGORIOU, JOHN P. DORMANS, ALEXANDRE ARKADER
International Journal of Spine Surgery Aug 2020, 14 (4) 615-622; DOI: 10.14444/7082

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Primary Aneurysmal Bone Cyst of the Spine in Children: Updated Outcomes of a Modern Surgical Technique
EMMANOUIL GRIGORIOU, JOHN P. DORMANS, ALEXANDRE ARKADER
International Journal of Spine Surgery Aug 2020, 14 (4) 615-622; DOI: 10.14444/7082
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