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Surgical management of a lumbar spine posterior element aneurysmal bone cyst in a child

The estimated annual incidence of aneurysmal bone cysts (ABCs) is 1.4 cases/100,000 people. Around 8%–30% of ABCs are located in the spine, which represents approximately 15% of all spinal tumors. Although ABCs are benign tumors, they can be locally aggressive and cause destruction of their hosting bones and pathological fractures. In spine ABC cases, compression of the spinal cord or instability of the spine might occur, and an urgent decision must be taken. We present a case of an 11-year-old boy who was found to have a second lumbar (L2) vertebral ABC and failed two sessions of sclerotherapy with a progression of the cyst that led to spinal compression. The decision was taken for surgical intervention with bone grafting and posterior instrumentation (L2–3) as there was instability due to facet destruction. We present a good outcome for surgical excision and short-segment fixation with a fusion of lumbar spine ABC in a patient who failed sclerotherapy in terms of cord decompression and a lower chance of recurrence.