vertebral body cyst radiology

Differential diagnosis of the spinal lesion can be narrowed by patients age, history, laboratory test, imaging studies and location of the tumor. The vast majority of discal cysts, as rare as they are,have been reported in males (M:F 9:1), typically of Asian ethnicity 1,2. MR images show a multiloculated mass of heterogeneous signal intensity that usually has blood products within (7). Aneurysmal bone cysts consist of multiloculated blood-filled spaces of variable size separated by fibrous septa,surrounded by a thin reactive bone formation rich in multinucleated osteoclast-like giant cells 1. In the spine, the most typical site of localization is the sacrum; other vertebral segments are rarely involved (7). The surgical intervention, when required, consists of primary closure of the dural defect through a posterior approach, accompanied by laminectomy and/or costotransversectomy.1 Although rare, arachnoid cysts can be a complication of Simple bone cysts are common, benign, fluid-filled, cystic lesions that cause minimal expansion of the bone and occur mostly in the metaphysis of long bones. The histopathology showed a pattern compatible with an aneurysmal bone cyst. CT proved to be more useful in the initial assessment and measurement of progress of this disease than conventional radiography and myelography. The most frequent sites are proximal humerus and proximal femur [1, 3]. 2. 9. The laboratory tests including complete blood count, renal function tests, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, serum calcium, serum phosphorus and parathyroid hormone were all within normal limits. Aneurysmal bone cysts are typically characterized by their lobulated and multiseptated appearance with fluid-fluid levels and blood degradation products on MR images. Aneurysmal bone cysts are poorly vascular 10. Giant cystic Schmorl's nodes are unusual entities; their radiologic appearance differs dramatically from the classic description and is diagnostically challenging. Summary of 2 new cases and 21 reported cases of bone cyst of lumbar vertebral body. A 24-year-old male presented with acute low back pain with no prior traumatic events. On CT aneurysmal bone cysts are characterized as lucent bone lesions with a mean density higher than fat 7. The sensitivity to specify a vertebral lesion on an X-ray is difficult as well. ADVERTISEMENT: Supporters see fewer/no ads. Pediatr Radiol. Albany Medical Center Medical Imaging is a medical group practice located in Albany, NY that specializes in Emergency Medicine and Radiology. Rai A & Collins J. Percutaneous Treatment of Pediatric Aneurysmal Bone Cyst at C1: A Minimally Invasive Alternative: A Case Report. Taylor JR. Growth of human intervertebral discs and vertebral bodies. The stroma corresponds to septations with fibroblasts, spindle cells, osteoids, and numerous benign giant cells. solitary lucent bone lesion, high T1 or low T1 bone lesion, location within the bone (eccentric, central). Isabela Oliveira, MD - PGY-3, radiology resident, Department of RadiologyPatrcia Menandro, MD PGY-3, radiology resident, Department of RadiologyAntonio Rodrigues de Aguiar Neto, MD -radiologist, Department of RadiologyHospital da Restaurao Recife, PE Brazil, Spinal Aneurysmal Bone Cysts (ABCs): Optimal Management. When all of the radiologic findings were assessed, we concluded that the lesion had the characteristic radiologic appearance of a simple bone cyst. (2006) Proceedings (Baylor University. Michael A. Blake, Mannudeep K. Kalra. the sacroiliac joint. Although roentgenography is usually adequate to identify the simple bone cyst, CT and MR imaging should be used for diagnosis of lesions in anatomically complex locations such as the vertebrae. Axial nonenhanced CT scan with bone window of the fourth cervical vertebra. Cyst removed from a vertebral body Fig. AJR Am J Roentgenol. Pathology report confirmed the diagnosis of SBC and the patient received no further treatment (Fig. Aneurysmal bone cysts have been first described by the American bone pathologist Louis Lichtenstein in 1950 14. Causes of Subchondral Bone Cysts. Reference article, Radiopaedia.org (Accessed on 18 Jan 2023) https://doi.org/10.53347/rID-34279. SUMMARY: Vertebral compression fractures are very common, especially in the elderly. In the table the most common sclerotic bone tumors and tumor-like lesions in different age-groups are presented. Its imaging diagnosis is usually difficult, . Posterior spinal fusion was performed with instrumentation with pedicle screws from T10 to L2 and a mixture of autologous bone graft and allograft was used to achieve better fusion (Fig. Unicameral bone cyst. To our knowledge, only four were in cervical vertebrae (36), and the rest were in lumbar vertebrae (2, 4). (2003) ISBN: 9780781737975 -, 4. 2018;34:43-9. (2020) ISBN: 9789283245025 -. On plain radiography (and to a lesser degree, CT), the differential diagnosis includes most of the lesions included in the mnemonic FEGNOMASHIC. Cancer. Written by Dr. Anil T. Ahuja and other leading experts in the field, the second edition of Diagnostic Ultrasound: Head and Neck offers detailed, clinically oriented coverage of . Case study, Radiopaedia.org (Accessed on 18 Jan 2023) https://doi.org/10.53347/rID-149389, Real Hospital Portugus de Pernambuco - Recife, PE - Brazil. About this product. MRI of Bone and Soft Tissue Tumors and Tumorlike Lesions. Unable to process the form. 7. 19 (4): 423-4. Both of our patients were confirmed by pathology report and had a good prognosis and no recurrence in long-term follow-up (10 and 7 years). AJR Am J Roentgenol. The cartilaginous layer is related to the nucleus pulposus and annulus fibrosus and has an important role in intervertebral disc nutrition 1. Modic et al. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Giant cell tumors of the spine only accounts for 37% of primary bone tumors. Gas measures about -580 to -1000 HU in density 3. CT (Fig 2) of the cervical spine showed the expansile unilocular cystic lesion of the spinous process at C4 and cortical thinning of the bone. vertebral hemangioma. The vertebral endplate capillaries are tiny branches of interosseous arteries that ramify throughout the vertebral body. hemangioma, synovial cyst (10,11), abscess and epidural hematoma. B, Lamellar and spongy bone fragments containing bone marrow elements (hematoxylin-eosin stain 40). In conclusion, this study presents two cases of SBCs and reviews the literature. Table 1 gives a summary of previously reported SBCs of the vertebral column in English literature [626]. 4.Tomaszewski KA, Saganiak K, Gadysz T, Walocha JA. 2014: 545017. 18. Fibrous dysplasia and eosinophilic granuloma more commonly present as osteolytic lesions, but they can be sclerotic. According to the radiologic findings, the lesion was identified as a simple bone cyst, and the diagnosis was verified by surgical and histopathologic examinations. The enlarged cysts can compress the sciatic nerve, causing sciatica. 3. A: The differential diagnosis of aneurysmal bone cysts is giant cell tumor, chondroblastoma, chondromyxoid fibroma, osteoblastoma, eosinophilic granuloma, and telangiectatic osteosarcoma. 7-1 and 7-2 ). , who described a fetus in fetu with spinal . A complementary MRI performed as part of in-hospital management showed an incidental finding of a cystic lesion in the vertebral body of C2 (Figure 1). Aneurysmal bone cysts (ABC) are benign expansile osteoclastic giant cell-rich bony neoplasms, composed of numerous blood-filled channels and cystic spaces 1. Spine Instability Neoplastic Score can be used to evaluate spine instability [28, 29]. AJNR Am J Neuroradiol. 1950;3(2):279289. Steven P. Meyers. Aegerter and Kirkpatrick (11) proposed that the cause of the simple bone cysts is post-traumatic and posthemorrhagic, except the ones in the long bones. Corticosteroid injection had been described for lesion in the peripheral skeleton can be considered when the risk of fracture is low [30, 23]. Harry B. Skinner. Active unicameral bone cysts occur most frequently between the ages of 1 and 10 years. Back pain, often radiating to other parts of your body. To date, 10 cases of simple bone cysts have been reported in the literature (2), and those bone cysts involved vertebral bodies (three), spinous process (three), lamina (one), pedicle (one), both spinous processes and lamina (one), and all components of the vertebrae (one) (26). Thank you for your interest in spreading the word on American Journal of Neuroradiology. CT could precisely show and localize all niduses, and calcification was always detected. Unable to process the form. In the case of our patient, the radiologic findings were not suggestive of a giant cell tumor, because the cystic lesion was not destructive or aggressive and did not have multiple compartments or heterogeneous signal intensity and blood degradation products on MR images. Vertebral body endplates are anatomically-discrete structures that form the interface between the vertebral bodies and the adjacent intervertebral discs. UBCs are usually found in children in the 1st and 2nd decades (65% in teenagers) with the mean age at diagnosis being 9 years 8. Welcome, VIN Public! No enhancement was observed on T1-weighted images following contrast medium administration (Fig 5). There have been 21 cases of SBCs in English literature, and only 8 cases have been reported in the vertebral body. The most frequent presentation is due to pathological fracture1,2,6. Aneurysmal bone cysts are benign giant cell-rich lesions of unknown cause and are sometimes difficult to distinguish from other bone tumors 1-6. 1. This is referred to as the doughnut signwhich results in increased uptake peripherally and a photopenic center. Skeletal Radiol. MR signal characteristics for an uncomplicated lesion include 8,10: Fluid-fluid levelscan be seen in the setting of fibrous septations, which can enhance 8. The tumors may affect your spinal cord or the nerve roots, blood vessels, or bones of your spine. A 26-year-old male presented with pain over the lower lumbar area. Logout. The lateral view of radiographs of the cervical vertebrae demonstrated a faintly visible osteolytic lesion causing minimum expansion in the C4 vertebral spinous process (Fig 1). J Am Acad Orthop Surg. Benign osteoporotic and malignant vertebral compression fractures have extremely different management and prognostic implications. This condition is characterized by pain in the lower back and buttocks, and sometimes down the back of the legs. Considered the best method of diagnosis. If fractured the bone usually heals normally 5. Centrally flow voids are present, indicating a hypervascular nature. Notice that many benign osteolytic lesions that are . Often, however, they expand secondarily into the pedicles and vertebral body (7). WHO Classification of Tumours, 5th Edition. Roberts CC, Andrews CL et-al. Knowing the cyst's size and position will help the doctor develop a treatment plan. Abstract The computed tomographic (CT) appearance and the pain radiographic and myelographic findings of vertebral hydatid disease (caused by Echinococcus granulosus) in two patients are presented. The reported cases were more common in women (n=13, 61.9%) than men (n=8, 38.1%). No complications were identified. The thecal sac was partially encased, compressed and deviated to the right side. Vertebral body mass: differential diagnosis, Differential diagnosis of a vertabral body mass, 1. There is a minimally expansile lesion of the spinous process of C4 vertebra (arrow). The introduction of bone cement into the vertebral body produces a sclerotic appearance on radiographs and CT, distinguishing this from the lucent appearance of . Society of Skeletal Radiology- White Paper. (2012) ISBN: 9789350258835 -. 2016;36 (3): 801-23. Providers Overview Location Reviews. ADVERTISEMENT: Supporters see fewer/no ads. occupying most of the height of the L2 vertebral body (Figure 2). They compose 28% of all skeletal hemangiomas, and the thoracic spine is the most frequent location. SBCs were found in cervical (n=10, 47.6%), lumbar (n=10, 47.6%) and thoracic (n=1, 4.8%) regions. Top 3 Differentials in Radiology, A Case Review. Search for other works by this author on: University of Shahid Beheshti Medical Sciences. Vertebral pneumatocysts: uncommon lesions with pathognomonic imaging characteristics. Patients age, history, clinical and laboratory data and radiologic findings can help with the diagnosis [5]. The spinal column is not a common site for SBC [4]. In our cases, due to benign course of disease and imaging that suggested a benign lesion, we decided to do an open biopsy and definite surgery at the same time. MR imaging shows an expansile mass involving the T3 left-sided posterior arch and vertebral body, destroying the lamina and pedicle with epidural extension. General imaging differential considerations include 8,10: giant cell tumor of bone:usually older, extending to the articular surface, non-ossifying fibroma: eccentric, cortical base, aneurysmal bone cyst (ABC): usually eccentric, differential diagnosis of expansile lytic lesions without cortical destruction of bone. 2004;232(2):522-6. Regarding the comparative study among CT and Detection of associated intradiscal gas and communication between the vertebral and intradiscal gas can be demonstrated. Disc cysts appear as sharply circumscribed lobulated cystic lesions in the anterior epidural space communicating with the disc space via a stalk through an annular fissure. A, Chondroid metaplastic foci in the connective tissue surrounding the lesion (hematoxylin-eosin stain 100). (2009) -, 3. Lesions coming from the cervico-brachial plexus are expected to be found in more paraspinal locations. 1995;164(3):573-80. Mosby. The patient reports progressive thoracic pain, loss of strength at the T4 sensory level, gradual deterioration of neurological status with lower limb paralysis, and loss of sphincter control. A: Aneurysmal bone cysts may be associated with other tumors like chondroblastoma, chondromyxoid fibroma, fibrous dysplasia, and giant cell tumor. (2006) ISBN: 9780781753586 -, 5. Welcome VIN Logout 2002;179 (3): 667-9. Unicameral bone cysts (UBC),also known as simple bone cysts (SBC) are common benign non-neoplastic lucent bony lesions that are seen mainly in childhood and typically remain asymptomatic. They rarely extend into the nearby ribs or adjacent vertebrae. Guidelines for the Diagnostic Management of Incidental Solitary Bone Lesions on CT and MRI in Adults: Bone Reporting and Data System (Bone-RADS). Rapp T, Ward J, Alaia M. Aneurysmal Bone Cyst. JMSR. The imaging evaluation includes computed tomography (CT), myelogra-phy and magnetic resonance imaging (MRI). There were no blood cells in its cavity and the characteristic morphology of an aneurysmal bone cyst in its wall was absent. 7. We intend to report two cases of SBC located in the vertebral body, and review the literature. This case illustrates the radiological findings of an aneurysmal bone cyst with the typical MRI fluid-fluid levels and septations separating the cysts. 11. Depending on the type of surgery. This study presents two cases of spinal SBC managed surgically with no recurrence in long-term follow-up. Soft Tissue and Bone Tumours. Mauricio Castillo. 1). AJNR Am J Neuroradiol. MRI of the Spine. Aydin S, Abuzayed B, Yildirim H et-al. 2010;19 (10): 1621-6. spinal infection / inflammation / degeneration. It might show concerning features such as cortical breach or soft tissue extension 7,8. 1. SBC accounts for the 'S' in the popular mnemonic for lucent bone lesions FEGNOMASHIC. (2014) ISBN: 9781907816222 -. Until now, to our knowledge, only 10 cases of a simple bone cyst involving the vertebrae have been reported, with four of them in the cervical vertebrae. Topouchian V, Mazda K, Hamze B, Laredo J, Penneot G. Aneurysmal Bone Cysts in Children: Complications of Fibrosing Agent Injection. Solid variant ABC of long tubular bones: A diagnostic conundrum for the radiologist. Imaging technology precisely guides minimally invasive procedures with needles, catheters and other devices. Microsurgical resection is the more common alternative if symptomatically required 1,2. The exact pathogenesis of the lesion is unknown [2]. Veena Chowdhury, Arun Kumar Gupta, Niranjan Khandelwal. Patients may present with pain, paresthesias, paraplegia, motor deficits, sphincter impairment, and myelopathy. Unicameral bone cysts occur almost exclusively in children and adolescents (85%). The recurrence rate of 15-30% has been described 3. We intend to report two cases of SBC located in the vertebral body, and review the literature. No neurologic deficits or abnormal values were noted on physical examination or in laboratory data. Blumberg M. CT of Iliac Unicameral Bone Cysts. Unable to process the form. However in patients older than 40 years, while dealing with posterior element lesions, metastasis must always be kept in mind. Although they are benign, aneurysmal bone cysts can display different clinical natural courses: quiescent, active or aggressive. 1991;21(2):114-6. Thus patients should be referred to an orthopedic oncologist 7. The most common differential diagnoses for SBC are aneurysmal bone cyst, brown tumor (hyperparathyroidism), infection and less commonly giant cell tumor. 1. 2000;8(4):217-24. Subach B, Copay A, Martin M, Schuler T, Romero-Gutierrez M. An Unusual Occurrence of Chondromyxoid Fibroma with Secondary Aneurysmal Bone Cyst in the Cervical Spine. Plain radiographs are the first-line imaging modality. Giant cell tumors are expansile, lytic, locally aggressive, primary benign bone tumors with thinning of the cortex. Most of the simple bone cysts are asymptomatic, unless they come with pathologic fracture. . Spinal Cyst Treatment Conservative treatment may include rest, anti-inflammatory medications, painkillers, steroid injections and drainage. A soft tissue mass is often present. Both genders are equally affected 1. Uncommon Manifestations of Intervertebral Disk Pathologic Conditions. (2011) ISBN:1609139437. The pain can. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Lumbar X-ray showed mild height loss and fracture of the superior endplate of T12 vertebra (Fig. The spinous process and the lesion within were removed. Vertebral body endplatesare anatomically-discrete structures that form the interface between the vertebral bodies and the adjacent intervertebral discs. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. 8. Bone mineral density in cystic fibrosis: benefit of exercise capacity. Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, et al. 8). Detection of associated intradiscal gas and communication between the vertebral and intradiscal gas can be demonstrated. Radiographics. Minimally invasive techniques are used to diagnose and treat vertebral disc problems and many other conditions of the spine. Lung laceration occurred in 46/364 dogs with thoracic trauma (prevalence 12.6%). Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Adam Greenspan, Gernot Jundt, Wolfgang Remagen. 4. Bone and Soft Tissue Tumors. Lesions can enlarge in size 1. Grossly aneurysmal bone cysts are well-defined multiloculated blood-filled cystic lesions with sponge-like septae and a peripheral component that is surrounded by a reactive thin bony shell 1. (Table 1). ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Dhnert WF. The following molecular criterion is desirable: USP6 gene (at 17p13.2 locus) rearrangement; occurs in 63% of cases. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gaillard F, Hacking C, Weerakkody Y, et al. 14. Surgery shows promising outcomes in large SBCs in the vertebral body with a high risk of fracture. MAIN: : Radiology of the Spine. (1975) Journal of anatomy. Every spine lesion should be approached carefully and pathologic confirmation is prudent. 2012;20(4):233-41. especially posterior elements of the spine with extension into the vertebral body in 40% of cases 5. obturator foramen in . Internal signal heterogeneity, periosteal reaction and soft tissue edema can be seen in the setting of fracture 8. (518) 262-3773. The definitive diagnosis of aneurysmal bone cysts is based on a combination of typical radiological and pathological features. They are classically first imaged by X-ray and subsequently confirmed by CT or MR imaging. Some of them are found in diaphysis. Jeffrey Stuart Ross. (2006) ISBN: 9781588902221 -, 2. Conclusion: T3 vertebral lytic lesion. Figure 7-3 Sacral Aneurysmal Bone Cyst. Current Diagnosis & Treatment in Orthopedics. 4.197a, b Osteoporosis in 10-year-old boy with Duchenne muscular . MRI is required for assessment of these lesions. Enter multiple addresses on separate lines or separate them with commas. Imaging examinations of 5 patients with pathologically confirmed spinal ABC were analysed and arterial angiography and embolization were performed prior to surgery. . ADVERTISEMENT: Supporters see fewer/no ads. A case report and review of literature, Solitary bone cyst of the cervical spine--case report, Solitary bone cyst in the odontoid process and body of the axis. mri Axial T2 Sagittal T2 Sagittal STIR Sagittal T1 Sagittal T1 fat sat Axial T1 C+ Sagittal T1 C+ MRI Axial T2 17. The aim of this review is to . 2020;68(4):843. In the case of our patient, the lesion did not cause any such fracture in the bone. Nayman A, Guler I, Erdogan H, Koplay M. Funayama T, Gasbarrini A, Ghermandi R, Girolami M, Boriani S. Boude AB, Vsquez LG, Alvarado-Gomez F, Bedoya MC, Rodrguez-Mnera A, MoralesSaenz LC. Radiology Cases of Vertebral Body Anomalies Radiology Cases of Hemivertebra AP image from a selective angiogram injection of the left renal artery shows fusion of the medial aspect of the left kidney, which has crossed the midline, to the medial aspect of the right kidney, causing the right kidney to be displaced laterally. Fig. Simple or solitary bone cysts (SBC) also known as unicameral bone cysts are benign lesions commonly seen in the peripheral skeleton [1]. The lesion can be categorized according to the bone reporting and data system as Bone-RADS 4 unless histology has been already obtained 7. Reference article, Radiopaedia.org (Accessed on 18 Jan 2023) https://doi.org/10.53347/rID-7189, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":7189,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/unicameral-bone-cyst-1/questions/2234?lang=us"}. Vertebral bodies and long limb bones were visualized. Radiographic evaluation of vertebral body lesions has three goals: (1) to identify lesions, (2) characterize lesions and generate a differential diagnosis, and (3) assess for associated complications (in particular cord compression) and treatment response. OA can happen from simple wear and tear over time, or because of a sudden injury to a joint . At present, there is no gold standard for treatment for SBCs and Surgery may not be the optimal treatment for patients except for large lesions or pathologic fracture [21]. vertebral hemangioma is the most common spinal axis tumor. The current study aimed to investigate the imaging manifestations of vertebral aneurysmal bone cyst (ABC), and examine the clinical value of interventional embolization. 15. Simple bone cysts usually lead to fracture of the bone; therefore, some of these fractures may cause the migration of a fractured bone tissue into the cystic cavity. 3). Alanazi O, Alshebromi A, Albaz A, Bassi M. Thoracic Spine Aneurysmal Bone Cyst Causing Paraplegia in a Child: A Case Report. The patient underwent surgery to remove the suspected simple bone cyst in the C4 vertebra. (2000) ISBN: 9780781725286 -, 4. histological evidence that cyst walls are composed of fibroblasts, osteoclastic giant cells, and hemosiderin pigment as well as proof of new bone formation . Roentgenography usually shows simple bone cysts as well-defined, intramedullary, metaphyseal, and pure lytic lesions. . MRI showed a well-defined low signal lesion in T1 weighted images and high signal lesion in T2 weighted images (Fig. Here an illustration of the most common sclerotic bone tumors. The lesion appeared homogeneous and hyperintense on axial T2*-weighted images, and no blood degradation products were observed (Fig 4). New York Downtown Hospital is a medical group practice located in New York, NY that specializes in Physician Assistant (PA) and Diagnostic Radiology. Vertebral pneumatocyst. If large and threatening to fracture, or causing deformity then an intralesional steroid injection can be performed 3-5. The radiologic appearance of the lesion of our patient was not multiloculated and did not have fluid-fluid levels, blood degradation products, or soft tissue around the lesion. Caro P, Mandell G, Stanton R. Aneurysmal Bone Cyst of the Spine in Children. Broadly, these lesions can be separated into: aneurysmal bone cyst(<2%): neural arch (60%); vertebral body (40%), Brown tumor(an osteoclast reaction in hyperparathyroidism). The etiology of these discal cysts remains uncertain, but they are believed to occur due to traumatic disruption of the annulus with subsequent accumulation of fluid, which forms a surrounding pseudocapsule 1,2. Develop a solid understanding of head and neck ultrasound with this practical, point-of-care reference in the popular Diagnostic Ultrasound series. Lovell and Winter's Pediatric Orthopaedics. Figure 1: distribution of unicameral bone cysts, Case 7: with classic "fallen fragment" sign, Case 14: with pathological humeral shaft fracture, bizarre parosteal osteochondromatous proliferation (Nora lesion), conventional intramedullary chondrosarcoma, dysplasia epiphysealis hemimelica (Trevor disease), solitary bone plasmacytoma with minimal bone marrow involvement, mixed lytic and sclerotic bone metastases, Lodwick classification of lytic bone lesions, Modified Lodwick-Madewell classification of lytic bone lesions. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Sciacca F, Bell D, Thurston M, Vertebral body endplate. 3 These . Medical Center). Although Bloodgood first recognized simple bone cysts as a distinct disease entity in 1910, Jaffe and Lichtenstein (1) were the first to provide a detailed description of the simple vertebral bone cyst in 1942. Hence, we used all these three imaging techniques to make a complete diagnosis. The patient underwent surgery and the lesion was extracted through the right pedicle and the remaining cavity was filled with an autologous bone graft from the iliac crest and right-side posterior fusion was done from L4 to L5 (Fig. Histologically, ABC is typically characterised by blood-filled cystic spaces separated by a spindle cell stroma with osteoclast-like giant cells and osteoid or bone production.

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