Percutaneous treatment of symptomatic aneurysmal bone cyst of L5 by percutaneous injection of osteoconductive material (Cerament)

We present a case report of a 33-year-old woman with back pain for several months which was resistant to medical treatment. Thoracolumbar MRI and multidetector CT showed an aneurysmal bone cyst intersecting the body and pedicles of L5. Minimally invasive treatment was performed with percutaneous inj...

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Bibliographic Details
Published in:BMJ case reports 2013-11, Vol.2013, p.bcr2013010912
Main Authors: Guarnieri, Gianluigi, Vassallo, Pasquale, Muto, Massimo, Muto, Mario
Format: Article
Language:English
Subjects:
Adult
Analgesics
Bone Cements - therapeutic use
Bone Cysts, Aneurysmal - complications
Bone Cysts, Aneurysmal - diagnosis
Bone Cysts, Aneurysmal - therapy
Calcium Sulfate - therapeutic use
Cement
Cysts
Drug Combinations
Durapatite - therapeutic use
Female
Follow-Up Studies
Humans
Hydroxyapatite
Injections, Intralesional
Injections, Spinal
Low Back Pain - etiology
Low Back Pain - physiopathology
Low Back Pain - therapy
Lumbar Vertebrae
Magnetic Resonance Angiography - methods
Multidetector Computed Tomography - methods
Orthopedic Procedures
Pain
Pain Measurement
Pain, Intractable - etiology
Pain, Intractable - physiopathology
Pain, Intractable - therapy
Patients
Risk Assessment
Severity of Illness Index
Spine
Treatment Outcome
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Summary:We present a case report of a 33-year-old woman with back pain for several months which was resistant to medical treatment. Thoracolumbar MRI and multidetector CT showed an aneurysmal bone cyst intersecting the body and pedicles of L5. Minimally invasive treatment was performed with percutaneous injection of osteoconductive cement (Cerament) to induce sclerosis and bone remodeling of the bone cyst lesion with an analgesic effect. Before treatment, spinal angiography was performed to exclude arterial afferents. No bone biopsy was done. Under general anesthesia and fluoroscopic guidance, a first vertebroplasty was performed by a bilateral transpedicular approach using the osteoconductive cement followed 2 months later by a second treatment with CT-fluoro-guided direct injection of Cerament. No complications occurred during the procedure. At 4 and 6 months follow-up the MRI/CT showed sclerotic bone remodeling of the walls of the aneurysmal cyst with clinical improvement.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2013-010912