title: Aneurysmal bone cyst of the first cervical vertebrae in a child treated with percutaneous intralesional injection of calcitonin and methylprednisolone. A case report.
abstract: METHODS
  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.
  
  
  OBJECTIVE
  To describe a safe and effective nonsurgical treatment method for an ABC of the first cervical vertebrae.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Orthopaedics, Naval Medical Center San Diego, San Diego, California, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Gladden
authors.forename: B L
authors.initials: BL
authors.lastname: Gillingham
authors.forename: W
authors.initials: W
authors.lastname: Hennrikus
authors.forename: L M
authors.initials: LM
authors.lastname: Vaughan
mesh_terms: D017824:Bone Cysts, Aneurysmal / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D002116:Calcitonin / Q000008:administration & dosage*; D001270:Cervical Atlas / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed
chemical_list: D002116:Calcitonin; D008775:Methylprednisolone