title: Efficacy and Safety of Selective Arterial Embolization in the Treatment of Aneurysmal Bone Cyst of the Mobile Spine: A Retrospective Observational Study.
abstract: METHODS
  A retrospective observational study.
  
  
  OBJECTIVE
  Our aim is to define the efficacy and safety of serial selective arterial embolization (SAE) in the treatment of aneurysmal bone cysts (ABCs), to explore potential treatment alternatives, and to define a therapeutic algorithm.
  
  
  BACKGROUND
  ABC is a benign lesion with an unpredictable behavior. Its treatment is challenging especially in poorly accessible surgical areas, such as spine and pelvis. Currently, the first-line treatment of ABC is repeated SAE until healing. Other options have been used with variable success rates.
  
  
  METHODS
  From January 2004 to September 2015, 23 patients affected by ABC of the mobile spine have been treated with SAE and prospectively followed up by computed tomographic scan and magnetic resonance imaging. Signs of neurological deficit, complications, healing of the lesion, and clinical outcomes were registered.Signs of healing are defined as peripheral sclerotic bone rim formation, decrease of the ABC mass, disappearance of the double content image, and bone formation inside the ABC mass, associated with remission of pain.
  
  
  RESULTS
  Twenty-three patients underwent SAE according to the protocol. Seventeen patients have healed. The number of procedures necessary to obtain healing (clinical and radiographic) varied from 1 to 10. No complication occurred during the procedure. Follow-up time ranged from 5 to 120 months after the last angiographic procedure. All 17 patients had complete relief of pain symptoms. Six patients did not respond to SAE, presenting a progressive clinical and radiographic worsening, and underwent other medical or minimally invasive treatments.
  
  
  CONCLUSIONS
  Our study confirms the safety of SAE. The efficacy of the treatment was however lower than expected. SAE is indicated when pathological fracture or signs of cord damage are not detected. Infiltration with autologous bone marrow concentrate or administration of Denosumab is under investigation as alternative choices of treatment.
  
  
  METHODS
  4.
authors.affiliation: Department of Oncological and Degenerative Spine Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Terzi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gasbarrini
authors.forename: Mario
authors.initials: M
authors.lastname: Fuiano
authors.forename: Giovanni
authors.initials: G
authors.lastname: Barbanti Brodano
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ghermandi
authors.forename: Stefano
authors.initials: S
authors.lastname: Bandiera
authors.forename: Stefano
authors.initials: S
authors.lastname: Boriani
mesh_terms: D000293:Adolescent; D000328:Adult; D017824:Bone Cysts, Aneurysmal / Q000000981:diagnostic imaging* / Q000628:therapy*; D002648:Child; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult