Aneurysmal bone cyst of the first cervical vertebrae in a child treated with percutaneous intralesional injection of calcitonin and methylprednisolone: A case report

Study Design. First published report of a child with an aneurysmal bone cyst (ABC) of the first cervical vertebrae treated successfully with intralesional injection of calcitonin and methylprednisolone. Objectives. To describe a safe and effective nonsurgical treatment method for an ABC of the first cervical vertebrae. Summary of Background Data. Aneurysmal bone cysts of the spine comprise from 3% to 20% of all such lesions. Upper cervical spine involvement is rare and these lesions are difficult to treat. Standard treatment with curettage and bone grafting or other alternatives such as radiation therapy or embolization may not be possible in this location. Percutaneous injection with a variety of agents has also been described. Methylprednisolone and calcitonin were selected in this case in an effort to combine the proposed angiostatic and fibroblastic inhibitory effects of steroid with the proposed osteoclastic inhibitory and promotion of new bony trabeculae formation effects of calcitonin. Method. This case was described, and pertinent literature reviewed. Results. Sclerosis and shrinkage of the lesion with concomitant symptom resolution occurred after two injections with calcitonin and methylprednisolone via computed tomography (CT) guidance. No complications occurred. The lesion remained quiescent at a 2-year 7-month follow-up. Conclusions. Percutaneous intralesional injection of an ABC of the first cervical vertebrae with calcitonin and methylprednisolone in a child via CT guidance was a safe and effective treatment. This is a promising treatment for surgically inaccessible aneurysmal bone cysts.