Kieser David C, Mazas Simon, Cawley Derek T, Fujishiro Takashi, Tavolaro Celeste, Boissiere Louis, Obeid Ibrahim, Pointillart Vincent, Vital Jean-Marc, Gille Olivier
Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Canterbury District Health Board, 2 Riccarton Avenue, Christchurch, 8011, New Zealand.
L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France.
Eur Spine J. 2018 Apr;27(4):851-858. doi: 10.1007/s00586-018-5470-y. Epub 2018 Jan 22.
To assess the efficacy of bisphosphonate therapy in the management of spinal aneurysmal bone cysts (ABCs).
A prospective study of six consecutive patients aged between 7 and 22 years with spinal ABCs treated with pamidronate (1 mg/kg) or zoledronate (4 mg). A visual analogue scale (VAS) for pain and radiological (contrast-enhanced MRI and CT scan at 3 and 6 months, then yearly X-rays) follow-up was continued for a minimum of 6 years.
One patient with an unstable C2/3 failed to respond to a single dose of bisphosphonate and required surgical resection and stabilisation with autologous bone grafting. Another, with a thoraco-lumbar ABC, experienced progression of neurological dysfunction after one cycle of bisphosphonate and, therefore, required surgical resection and stabilisation. In all other patients pain progressively improved and was resolved after two to four cycles (VAS 7.3-0). These patients all showed reduction in peri-lesional oedema and increased ossification by 3 months. No patients have had a recurrence within the timeframe of this study.
Bisphosphonate therapy can be used as the definitive treatment of spinal ABCs, except in patients with instability or progressive neurology, where surgical intervention is required. Clinicians should expect a patients symptoms to rapidly improve, their bone oedema to resolve by 3 months and their lesion to partially or completely ossify by 6-12 months.
评估双膦酸盐疗法在治疗脊柱骨囊肿（ABCs）中的疗效。
对6例年龄在7至22岁之间的连续脊柱ABCs患者进行前瞻性研究，给予帕米膦酸（1mg/kg）或唑来膦酸（4mg）治疗。采用视觉模拟评分法（VAS）评估疼痛情况，并通过影像学检查（3个月和6个月时进行增强磁共振成像和CT扫描，之后每年进行X线检查）进行至少6年的随访。
1例C2/3不稳定的患者对单剂量双膦酸盐治疗无反应，需要进行手术切除并采用自体骨移植进行稳定治疗。另1例胸腰段ABC患者在一个双膦酸盐治疗周期后神经功能障碍进展，因此也需要进行手术切除并稳定治疗。在所有其他患者中，疼痛逐渐改善，在两到四个周期后缓解（VAS从7.3降至0）。这些患者在3个月时均显示病变周围水肿减轻，骨化增加。在本研究的时间范围内，没有患者复发。
双膦酸盐疗法可作为脊柱ABCs的确定性治疗方法，但不稳定或神经功能进行性恶化的患者需要手术干预。临床医生应预期患者症状会迅速改善，骨水肿在3个月内消退，病变在6至12个月内部分或完全骨化。
