Palmisciano Paolo, Hunter Madysen, Lokesh Nidhish, Bin Alamer Othman, Scalia Gianluca, Giammalva Giuseppe R, Maugeri Rosario, Iacopino Domenico G, Umana Giuseppe E, Haider Ali S
Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy.
University of Texas Southwestern Medical School, Dallas, TX, USA.
J Clin Neurosci. 2022 Jun;100:15-22. doi: 10.1016/j.jocn.2022.03.040. Epub 2022 Apr 1.
Spine aneurysmal bone cysts (ABCs) rarely occur in adults. Primary and secondary lesions may show some differences and require appropriate treatments.
To systematically review the literature on adult spine ABCs.
PubMed, EMBASE, Scopus, and Web-of-Science were searched. Clinical-radiological features, treatments, and outcomes were analyzed and compared between primary vs secondary adult spine ABCs.
We included 80 studies comprising 220 patients. Primary spine ABCs were more frequent (76.4%). Main symptoms were lower-back-pain (42.8%) and motor deficits (31.2%). Tumors were mostly thoracic (31.4%) or cervical (26.8%), showing lytic (70.4%) and/or cystic (52.3%) appearances. Surgical resection (79.1%) was preferred over biopsy (20.9%). Most primary ABCs underwent curettage with bone grafting (62.1%) and laminectomy (39.1%) (P < 0.001), while most secondary ABCs underwent corpectomy (51%) and spine fixation (93.9%) (P < 0.001). Radiotherapy was delivered in 58 patients (26.4%), and embolization in 37 (16.8%). Symptomatic improvement was reported in 91.8% cases, with no differences based on etiology nor extent-of-resection. Median follow-up was 28.5 months, significantly superior in secondary ABCs. Secondary ABCs had significantly higher rates of tumor recurrence (19.2%; P = 0.011) and death (5.8%; P = 0.002).
Surgical resection, radiotherapy, and embolization are effective in managing adult spine ABCs. Secondary tumors have worse prognoses requiring more aggressive treatments.
脊柱动脉瘤样骨囊肿（ABCs）在成人中很少见。原发性和继发性病变可能表现出一些差异，需要适当的治疗。
系统回顾关于成人脊柱ABCs的文献。
检索了PubMed、EMBASE、Scopus和Web of Science。分析并比较了原发性与继发性成人脊柱ABCs的临床放射学特征、治疗方法和结果。
我们纳入了80项研究，共220例患者。原发性脊柱ABCs更为常见（76.4%）。主要症状为下背部疼痛（42.8%）和运动功能障碍（31.2%）。肿瘤大多位于胸椎（31.4%）或颈椎（26.8%），表现为溶骨性（70.4%）和/或囊性（52.3%）。手术切除（79.1%）比活检（20.9%）更受青睐。大多数原发性ABCs采用刮除植骨术（62.1%）和椎板切除术（39.1%）（P < 0.001），而大多数继发性ABCs采用椎体次全切除术（51%）和脊柱固定术（93.9%）（P < 0.001）。58例患者（26.4%）接受了放疗，37例（16.8%）接受了栓塞治疗。91.8%的病例报告有症状改善，病因和切除范围不同无差异。中位随访时间为28.5个月，继发性ABCs明显更长。继发性ABCs的肿瘤复发率（19.2%；P = 0.011）和死亡率（5.8%；P = 0.002）明显更高。
手术切除、放疗和栓塞治疗成人脊柱ABCs有效。继发性肿瘤预后较差，需要更积极的治疗。
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