title: Circumferential vertebrectomy with reconstruction for holocervical aneurysmal bone cyst at C4 in a 15-year-old girl.
abstract: METHODS
  The authors describe the unique case of a 15-year-old girl with a holovertebral aneurysmal bone cyst at C4, causing anterolisthesis and kyphosis, who underwent circumferential vertebrectomy with reconstruction and rigid fusion.
  
  
  OBJECTIVE
  To report an unusual manifestation of aneurysmal bone cyst, requiring special considerations for surgery. The discussion highlights emerging principles for treatment of this lesion, and cervical spine fusion, in the pediatric population.
  
  
  BACKGROUND
  There is no previous report of a holovertebral aneurysmal bone cyst of the pediatric cervical spine. The potential for neurologic or vascular compromise from this lesion is substantial if left untreated, and the risk of recurrence or other morbidity is significantly higher unless completely resected.
  
  
  METHODS
  A 15-year-old white female presented with a 4-month history of neck pain after a mild injury, but was neurologically intact. Diagnostic imaging revealed a holovertebral, multicystic, and osteolytic lesion with multiple fluid-fluid levels in the fourth cervical vertebra. Total vertebrectomy and repair were performed with fibular strut grafts and placement of rigid anterior and posterior instrumentation. This was accomplished in a single anteroposterior operative pass.
  
  
  RESULTS
  Surgical treatment produced a stable bony fusion with no neurologic or vascular sequelae. This approach minimizes the risk of recurrence and the possibility of postoperative spinal instability.
  
  
  CONCLUSIONS
  Spinal aneurysmal bone cyst in children presents diverse challenges. These lesions should be treated with complete resection to minimize the chance of recurrence. In pediatric cases, defects created by resection should be corrected by fusion to minimize the risk of postoperative instability and growth abnormality. One-year followup demonstrated a stable construct, and the patient remains neurologically at her baseline.
authors.affiliation: Department of Neurosurgery, Washington University in Saint Louis, School of Medicine, Saint Louis, MO 63110, USA. refaid@nsurg.wustl.edu
authors.forename: Daniel
authors.initials: D
authors.lastname: Refai
authors.forename: Terrence
authors.initials: T
authors.lastname: Holekamp
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Stewart
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Leonard
mesh_terms: D000293:Adolescent; D017824:Bone Cysts, Aneurysmal / Q000473:pathology / Q000601:surgery*; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000517:prevention & control; D008279:Magnetic Resonance Imaging; D019547:Neck Pain / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods*; D013123:Spinal Fusion / Q000379:methods*; D014057:Tomography, X-Ray Computed