Transoral vertebroplasty for a C2 aneurysmal bone cyst.

BACKGROUND CONTEXT: Aneurysmal bone cysts at the cervical spine represent a real challenge both diagnostically and therapeutically, especially in young patients.

PURPOSE: We present an unusual case of a C2 aneurysmal bone cyst expanding in the entire vertebral body in a girl successfully treated with a transoral vertebroplasty.

STUDY DESIGN: This is a case report study.

METHODS: We report the case of a 17-year-old girl with a history of cervical pain and occipital headache after a car accident. Routine x-rays disclosed a C2 lesion. Her neurologic examination was normal. Computed tomography showed a lytic lesion occupying almost the entire body of the C2 vertebra. The cortical bone was intact but notably thinned. Magnetic resonance imaging revealed a cystic image with blood inside. Transoral vertebroplasty was selected among other surgical options for the following reasons: (1) to improve the clinical symptoms, and (2) to prevent future vertebral collapse with devastating neurologic consequences. Under general anesthesia and continuous neurophysiological monitoring, we conducted a fluoroscopic-guided transoral vertebroplasty through a Jamshidi needle. A cytology sample from the cystic lesion was taken through the needle.

RESULTS: The blood smear showed no tumoral cellularity. There were no complications during surgery or postoperative infections. After 4 years of follow-up, the patient is pain-free and leads a normal life.

CONCLUSIONS: Transoral vertebroplasty seems to be a direct, safe, and effective technique to stabilize cystic lesions that endanger the stability of C2 and to improve symptoms. Aneurysmal bone cysts should be included in the differential diagnosis of lytic lesions at the C2 vertebral body.