Large lumbar anurysmal bone cyst presenting as an abdominal mass. Management and outcome

Abstract

Background Data: Aneurysmal bone cysts (ABCs) of the spine account for 12 to 30% of all ABC cases. They mostly occur in the lumbar vertebrae, followed by the thoracic, cervical, and sacral vertebrae. Despite being benign, they can be locally expansive and destructive, and can result in pathological fractures of the vertebrae and neurological complications. Treatment modalities include surgical resection, radiotherapy, and embolization with reconstruction. Purpose: To report on a rare case of very large aneurysmal bone cyst originating from the body and the posterior arch of L3 vertebrae and extending from the paraspinal sub-cutaneous tissue posteriorly to the anterior abdominal wall anteriorly and pushing the kidney up and explaining the way of management of such cases. Study Design: Case report and review of literature. Patient and Methods: An 18years old female patient presented with back pain, right lower limb numbness and partial foot drop together with a big abdominal mass. A thorough general and neurological examination proceeded by proper history taking including family history and previous trauma were done. Radiological workup was done in the form of plain X-ray, CT scan, and MRI. Total excision and reconstruction was performed under general anesthesia through a posterior only approach. Results: Post operatively the patient recovered nicely without any neurological deficits within 2 weeks. Post operative CT showed total excision, adequate reconstruction and trans-pedicular screw fixation. This patient was followed up clinically for 8 months till now with very good neurological condition. Conclusion: Proper diagnosis and adequate surgical techniques are mandatory for proper surgical excision of such a very big ABC especially if highly vascular. (2014ESJ083)

Keywords

• Aneurysmal bone cyst (ABC)
• Lumbar
• Large