Challenging case: ABC tumor of the cervical spine

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The case

After sustaining an apparent neck injury during a routine soccer fall, a 12-year-old presented to a local hospital emergency room. An MRI was ordered and indicated an aneurysmal bone cyst (ABC) tumor in her cervical spine.

The patient was transferred from the local emergency room to the Boston Children’s Hospital Emergency Department.

A CT confirmed the original diagnosis and showed a fracture and erosion of her C-5 vertebra.

Guidelines for ABC tumors in long bones often recommend sclerotherapy prior to surgery. Initially, one recommendation was that the patient undergo sclerotherapy to shrink the tumor, and then undergo surgery to remove the remaining tumor in the future.

The patient was extremely active and eager to have surgery and begin rehabilitation. Her family asked for other options.

The plan

Daniel Hedequist, MD, orthopedic surgeon, and Mark Proctor, MD, interim neurosurgeon-in-chief, reviewed the case and the patient’s images.

“The risk for paralysis, stroke and further neurologic injury was higher than normal because the tumor was wrapped around her spine and vertebral artery,” says Hedequist. “In addition, the patient’s anatomy was completely distorted by the tumor and subsequent fracture.”

x-ray-c-spineHowever, Hedequist and Proctor had acquired considerable experience (approximately six patients/year) operating on patients with similar diagnoses and had completed a retrospective review of patients with spinal ABC cases at Boston Children’s. Since publication of the review, they had modified their approach to treatment because the review indicated pre-surgical embolization and sclerotherapy do not necessarily change patient outcomes. This patient avoided pre-surgical treatment.

The solution

After conferring, the surgeons recommended proceeding with surgery to remove the tumor and reconstructing the patient’s vertebra during the initial hospital stay.

The operation proceeded as planned. The patient complied with post-surgical physical therapy to improve range of motion and core strength and successfully returned to full activity nine months after surgery.

As is the case with many patients with ABC tumors, a small fraction of residual tumor remains. It was treated with sclerotherapy, and the patient is monitored via MRI every six to 12 months.

Learn more about the Boston Children’s Complex Spine Program.