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Aneurysmal bone cysts in the spine, causing neurological compromise: safety and clinical efficacy of sclerotherapy utilizing sodium Tetradecyl sulfate foam

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Abstract

Objective

To assess the clinical efficacy, technical feasibility, and safety profile of percutaneous sclerotherapy utilizing sodium tetradecyl-sulfate foam (STS) as a first-line treatment strategy for aggressive spinal aneurysmal bone cysts (sABCs) presenting with neurological compromise.

Materials and methods

Between July 2013 and September 2019, eight consecutive patients (5 males; 3 females; mean age 22±17, range 7–52) underwent fluoroscopic/CT-guided intraosseous sclerotherapy for sABCs. Pain and/or neurological compromise was the primary indications. Procedural data, complications, imaging, and clinical results were analyzed.

Results

Technical success was achieved in all cases. Mean procedure time was 25±15 min (range 6–167); 1 to 5 repeat treatment cycles (mean 3.7±1.2) utilizing a mean 2.6mls±1.3 (range 1–6) of agitated 3% STS, with a DLP mean dose of 158±91 mGy*cm (range 62–331) per procedure. One reported a minor complication (pain), but no significant complications. Two patients had persistent neurological deficit due to cord compression despite successful sclerotherapy, requiring surgical resection (and were thereby excluded from the final outcome analysis). The remaining six patients demonstrated a significant reduction in tumor volume (p = 0.028), pain (p = 0.027), and SINS (spinal instability neoplastic score) (p = 0.027) at up to 5 years of follow-up (mean 20 ± 16.7, range 7–51 months).

Conclusion

Percutaneous sclerotherapy with STS is a minimally invasive, technically feasible, safe, and effective first-line treatment for primary sABCs causing pain and neurological compromise, alleviating the need for extensive surgery. It is most effective with three or more treatment cycles, in patients with higher SINS, pain scores, or tumor volumes at the initial presentation.

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Abbreviations

STS:

Sodium tetradecyl sulfate

sABC:

Spinal aneurysmal bone cyst

PTRON:

Primary Tumor Research and Outcome Network

DLP:

Dose length product

CTCAE:

Common terminology criteria for adverse events

SINS:

Spinal instability neoplastic score

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Authors and Affiliations

  1. Department of Musculoskeletal Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, England, OX3 7LD, UK

    Danoob Dalili, James Teh & Ramy Mansour

  2. Department of Spinal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

    Jack Parker & Jeremy Reynolds

  3. Department of Orthopaedic Surgery and Musculoskeletal Medicine, Canterbury School of Medicine, University of Otago, Christchurch, New Zealand

    Jack Parker

  4. Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Arya Mirzaian

  5. Department of Vascular and Interventional Radiology, The John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

    Mark Bratby

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  1. Danoob Dalili
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Correspondence to Danoob Dalili.

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Dalili, D., Parker, J., Mirzaian, A. et al. Aneurysmal bone cysts in the spine, causing neurological compromise: safety and clinical efficacy of sclerotherapy utilizing sodium Tetradecyl sulfate foam. Skeletal Radiol 50, 2433–2447 (2021). https://doi.org/10.1007/s00256-021-03793-w

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