PMC7538958_01
Computed tomography of the spine. (a) Sagittal section showing typical expansile, osteolytic bony destruction of T9 vertebra with posterior epidural extension and cord compression. (b) Axial section showing lytic lesion with egg shell layer (marked with arrow) of the T9 body involving the left pedicle, lamina, and spinous process.
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F1
The computed tomography (CT) scan of the thoracic spine demonstrated an expansile lytic lesion with the classical "egg shell layer" occupying the left side of T9 vertebral body destroying the lamina and pedicle with epidural extension [Figure 1a and b]. The MR showed a bony, cystic mass with internal septation and fluid-fluid levels within the T9 vertebral body; on T1- and T2-weighted images, the lesion was heterogeneous with evident spinal cord compression [Figure 2a-d].
MRI of the spine. (a and b) T1- and T2-weighted sagittal image revealed a heterogeneous bony cystic mass with internal septation and fluid-fluid levels at the T9 vertebra. (c and d) Axial T1- and T2-weighted images showing large, expansile spinal lesion with multiple fluid levels typical for an aneurysmal bone cyst and cord compression.
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F2
The computed tomography (CT) scan of the thoracic spine demonstrated an expansile lytic lesion with the classical "egg shell layer" occupying the left side of T9 vertebral body destroying the lamina and pedicle with epidural extension [Figure 1a and b]. The MR showed a bony, cystic mass with internal septation and fluid-fluid levels within the T9 vertebral body; on T1- and T2-weighted images, the lesion was heterogeneous with evident spinal cord compression [Figure 2a-d].
Preoperative embolization. (a) Angiography showing intercostal feeder vessel. (b) Intercostal feeder vessel from T8 vertebra blocked with coil, also showing owl eyed (absent left pedicle) T9 vertebra below. (c) Intercostal feeder vessel to the left T9 vertebra blocked with coil.
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F3
The patient had SAE; intercostal feeders were embolized using coils and gel foam [Figure 3a-c].
(a) Intraoperative picture showing cord decompression left side excision of lesion. (b and c) Postoperative thoracic spine X-ray AP view and lateral view showing posterior spinal decompression and instrumented fusion T7-T11 with anterior cage reconstruction of T9 vertebra.
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F4
Within 48 h, he underwent a single stage posterior spinal decompression, with left- sided complete intralesional excision [Figure 4a]. This was accompanied by bone grafting/and cage placement for anterior column reconstruction; posteriorly, an instrumented fusion was performed utilizing titanium screws/rods from T7 to T11 [Figure 4b and c].
Cavernous spaces filled with blood surrounded by fibrous septa composed of a cellular proliferation of band fibroblasts, few spindle cells, and scattered giant cells.
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F5
Histopathological examination showed cavernous spaces filled with blood surrounded by fibrous septa with marked cellular proliferation of band fibroblasts, few spindle cells, and scattered giant cells consistent with the diagnosis of an ABC [Figure 5].
Computed tomography of the spine at the 5th month. (a) Sagittal section showing recurrence of lytic lesion at T9 vertebra with spinal stabilization. (b) Axial section showing lytic lesion at the right side of T9 vertebral body (marked with arrow) and cage with bone growth at previous left side lesion.
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F6
The repeat CT scan showed recurrence of the lesion; it now involved the right side of the T9 vertebral body [Figure 6a and b].
Computed tomography of the spine at end of 2 years. (a) Sagittal section showing complete bone T9 vertebra with intact stabilization and no signs of bony lysis. (b) Axial section showing peripheral sclerotic bone rim formation right side (marked with arrow) and bone formation inside the aneurysmal bone cysts mass.
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F7
At 2 years follow-up with MRI and CT studies, there was complete bone formation within the lytic areas [Figure 7a and b] and good pain relief.