Dr. Juan Pablo De León Palacios
MULTIMEDICA VISTA HERMOSA
Male Patient, 19 years old. Systems engineering student
Reason for Consultation: Cervical pain 2 months after surgery performed by another institution, with progressive limitation of movement, and failed surgery in 2 previous occasions.
History: Resection of cervical spine tumor 2 months ago (2nd), Resection of cervical spine tumor 6 months ago (1st)
- Patient began with sudden cervical pain in February 2006. He underwent studies and surgery in March. Partial resection of tumor at the third cervical vertebra to the fifth (C3-C4-C5) was documented.
- Two months later he consulted the same hospital once more for cervical pain radiating to the right arm.
- An increase in the tumor involving the third cervical vertebra to the sixth (C3-C4-C5-C6) was documented. Revision surgery was performed with partial resection of the tumor, bone graft and cervical plate fixation from the second to the sixth vertebra (C2-C6 with iliac crest graft).
- The patient’s family decides to consult our medical team and upon entry the young man did not present neck deformity, but did present numbness in his right arm. The test of the tumor sample (pathology) reported in the 2 previous surgeries matches an aneurysmal bone cyst (a benign spine tumor that behaves like a malignant tumor by presenting accelerated, erratic and unpredictable growth).
- After analyzing and discussing the case in the medical meeting, the performance of cervical column vertebral reconstruction in 2 steps (first a posterior support surgery and second: resection of the failed prosthetic material, plus complete tumor resection and reconstruction with a titanium mesh prosthesis filled with bone, and anterior support plate) was decided upon.
First Surgery: Posterior resection, fixation and osseous fusion from C2 to T2
Second Surgery: Resection, osseous fusion and fixation from C2 to C7.
Three years after tumor resection surgery and spine reconstruction involving the base of the second cervical vertebra to the base of the seventh cervical vertebra, there has been NO relapse. The patient returned to his daily life with no sequels.
ANEURYSMAL BONE CYST
- This primary and benign tumor pathology may behave as a malignant one with its aggressive growth.
- It represents 1.4% of all primary tumors and 20% of them happen in the vertebral column.
- The peak incidence occurs before 20 years of age and mostly in men. They are extremely rare after 30 years of age.
- They are mostly found in the area of the posterior elements of the cervical and dorsal column.
- Patients seek consultation for local pain and radicular or medullar neurological compromise.
- Expansile lytic lesions with a thin layer of cortical bone are observed with radiology.
- Small spaces inside the bone give the characteristic aspect of “soap bubbles”.
- The MRI presents “levels of liquid over liquid”.
- 40% of the ABCs may involve adjacent levels.
- Embolization is mandatory to reduce the tumor and the bleeding during the curettage and even though the combination of both is the gold standard, recurrence is above 50%.