Managing Persistent Cervical Aneurysmal Bone Cyst with Salvage Radiotherapy: A Case Report

Abstract

Aims: Aneurysmal bone cyst (ABC) is a benign yet locally aggressive bone lesion that can lead to significant morbidity when it involves the spine. Cervical spine involvement is particularly rare and poses significant management challenges because of its proximity to the spinal cord and major neurovascular structures, often limiting complete surgical excision. This report aims to highlight the role of salvage radiotherapy in managing residual cervical spine ABC following surgery. Presentation of Case: A 17-year-old girl presented with progressive swelling in the left side of the neck associated with pain and recent onset weakness in both lower limbs. Imaging revealed a large expansile multiloculated lesion involving the C2–C3 vertebrae, causing spinal cord compression. She underwent C2–C3 laminectomy with excision of the lesion and posterior fixation. Histopathology confirmed aneurysmal bone cyst. Postoperative imaging showed residual disease at the operative site. Considering the anatomical constraints and surgical morbidity, salvage external beam radiotherapy was delivered using three-dimensional conformal radiotherapy to a dose of 30 Gy in 15 fractions. The treatment was well tolerated, with gradual relief of pain and improvement in motor strength. Follow-up imaging demonstrated partial regression of the lesion. Discussion: Although surgery remains the cornerstone of treatment for ABC, residual or recurrent disease can occur when complete excision is not feasible. In such situations, carefully planned radiotherapy can provide effective local control and symptomatic relief while minimizing risks to the spinal cord. Conclusion: This case illustrates that moderate-dose conformal radiotherapy may serve as a valuable salvage option for persistent cervical spine ABC, particularly in anatomically complex regions where further surgery carries substantial risk.