Objective:

To describe a rare case of a thoracic aneurysmal bone cyst (ABC) successfully treated using a novel multimodal approach that combined preoperative spinal angiography and embolization with robotic assisted surgery. 

Background:

ABCs are rare, benign, highly vascular bone lesions that may affect the spine and cause neurological symptoms due to compression of neural structures. Their management poses challenges given the risk of intraoperative bleeding and proximity to critical anatomy. Although selective arterial embolization has been used as a standalone or adjunctive therapy to open surgery, the integration of embolization with robotic assisted spinal surgery has not been previously reported in the literature.

Design/Methods:

N/A

Results:

A 21-year-old woman presented with progressive mid back pain radiating bilaterally around the ribs at the T6 level. Motor, sensory, and reflex examination was significant for bilateral ankle clonus. Thoracic spine MRI revealed a 5.0 × 2.3 × 5.2 cm expansile lesion involving the posterior elements of the T6 vertebra, causing severe central canal stenosis and spinal cord compression. Spinal angiography demonstrated a hypervascular lesion supplied by the right T6 intercostal artery; embolization was performed successfully. The artery of Adamkiewicz was identified arising from the left T7 intercostal artery, informing surgical planning. The patient subsequently underwent T4-T8 instrumented fusion using robotic navigation, T5-T7 laminectomy, and resection of the T6 lesion. Pathologic examination confirmed an ABC. Postoperatively, the patient recovered well with mild transient mid thoracic numbness, and no recurrence at follow up. 

Conclusions:

This case highlights a novel, integrated approach to treating spinal ABCs that combines preoperative embolization with minimally invasive, robotic assisted resection and stabilization. This represents one of the first documented cases utilizing both modalities. The successful outcome underscores the potential of multimodal strategies to enhance outcomes in the management of highly vascular spinal lesions.