Deo Sunny D, Fairbank Jeremy C T, Wilson-Macdonald James, Richards Peter, Pike Michael, Athanasou Nicholas, Wheeler Kate
Great Western Hospital, Swindon, United Kingdom.
Spine (Phila Pa 1976). 2005 Feb 1;30(3):E80-2. doi: 10.1097/01.brs.0000152094.20585.c0.
Case report.
To report: 1) one of the youngest cases of aneurysmal bone cysts presenting with cord compression at the cervicothoracic junction with 7-year follow-up; and 2) the technique we used to stabilize such a small spine.
Aneurysmal bone cyst is an uncommon but well-recognized tumor affecting the spine of children. The mean age of presentation is 16 years. It has hardly been reported below the age of 4 years. All data are in the form of case reports or series. Surgical or nonoperative management can be used. Spinal implant systems are not designed for use in very small children.
Clinical data analysis.
A girl presented at age 2 years and 3 months with cord compression at the cervicothoracic junction. After an inconclusive biopsy, a formal excision and reconstruction of the C7 and T1 were performed anteriorly and posteriorly. We used a fibular graft, internal fixation with crossed plates from the maxillofacial implant tray and a Cervifix rod contoured into a rectangle with sublaminar titanium cables. Postsurgery, she had a left Horner syndrome that has never recovered and motor weakness of the right arm that improved but did not fully recover. She developed a staphylococcal infection 6 months postsurgery that was managed by removal of the rectangle. She developed a posterior recurrence 10 months postsurgery, which was managed surgically. Follow-up has been for 7 years without further evidence of recurrence.
Both surgical and nonsurgical management has been advocated for these tumors. The cord compression at presentation forced us toward surgical management. It is likely that observational data are the only evidence available for clinical decision-making. In this case, we were able to obtain good access to the front of the upper thoracic spine by a supraclavicular approach. Tiny plates are available to maxillofacial surgeons that can be adapted for use in the spines of small children.
病例报告。
报告：1）颈胸交界处出现脊髓受压的最年轻的动脉瘤样骨囊肿病例之一，并进行7年随访；2）我们用于稳定如此小的脊柱的技术。
动脉瘤样骨囊肿是一种罕见但已被充分认识的影响儿童脊柱的肿瘤。平均发病年龄为16岁。4岁以下很少有报道。所有数据均为病例报告或系列报道形式。可采用手术或非手术治疗。脊柱植入系统并非为非常小的儿童设计。
临床数据分析。
一名2岁3个月大的女孩在颈胸交界处出现脊髓受压。活检结果不明确后，先后从前路和后路对C7和T1进行了正式切除和重建。我们使用了腓骨移植，通过颌面植入托盘的交叉钢板进行内固定，并将一根Cervifix棒塑形为矩形，用椎板下钛缆固定。术后，她出现了左侧霍纳综合征，一直未恢复，右臂出现运动无力，有所改善但未完全恢复。术后6个月发生了葡萄球菌感染，通过移除矩形固定装置进行处理。术后10个月出现后路复发，再次进行了手术治疗。随访7年，无进一步复发迹象。
对于这些肿瘤，手术和非手术治疗均有提倡。就诊时的脊髓受压促使我们采取手术治疗。很可能观察数据是临床决策的唯一可用证据。在本病例中，我们通过锁骨上入路能够很好地显露上胸椎前方。颌面外科医生有可用于小儿脊柱的微型钢板。
