Successful outcome of adjuvant denosumab therapy in treating unresectable spinal aneurysmal bone cyst in a pediatric patient: A case report and literature review

Aneurysmal bone cysts (ABCs) are benign bone lesions that account for approximately 15% of all spine tumors. We present a case of an 8-year-old girl with a recurrent ABC of the cervical spine at the level of C3. She presented to the emergency department with myelopathy and weakness in her upper extremities 3 months after her initial surgery, which was a C3 corpectomy and fusion with iliac crest autograft followed by posterior decompression, tumor debulking, and instrumentation. The patient was not a candidate for complete surgical resection of the mass due to its encasement of the vertebral arteries. She underwent revision surgery with posterior marginal tumor resection and decompression of the cord. She then received adjuvant denosumab and demonstrated promising results, which were evident on computed tomography and magnetic resonance imaging as soon as 6 months post-denosumab treatment. This report also reviews the literature on treating ABCs and using adjuvant denosumab in the pediatric population.