背景/目的:动脉瘤性骨囊肿(ABCs)的手术治疗具有挑战性,尤其是脊柱。诸如denosumab的非手术治疗在不同的溶骨病理中显示出有希望的结果。这项回顾性观察性研究旨在评估接受denosumab治疗的可移动脊柱ABC患者的长期临床和放射学反应,并提出更新的治疗算法。方法:在2012年至2023年之间,对6例复发和有症状的活动脊柱ABC患者进行了denosumab(在第1、8、15、29天和此后每4周皮下注射120mg)治疗。在治疗后3、6、9和12个月使用CT和MRI进行疾病评估。临床数据,包括疼痛程度,症状,和不良事件,从患者的图表中记录。结果:患者接受了denosumab治疗的初始阶段,在中位随访期41个月(范围15-98个月)内,平均接受22次给药(范围13-42次).所有患者治疗4周后均有临床改善,所有患者在denosumab治疗12-24周后均表现出放射学反应。3例患者在13、15和42次给药后停用denosumab后无进展,分别。在最后一次随访中,在38、43和98个月之后,这些患者保持稳定,无疾病复发.三名患者在denosumab后疾病复发;其中两人接受了denosumab再次攻击,而一名患者接受了一次间充质干细胞(MSC)注射。所有患者均表现出临床和放射学改善,并在最后一次随访时无病。结论:这项研究证明了denosumab治疗可移动脊柱ABC的长期疗效和安全性,以及在控制复发方面再次挑战的可能性。提出了一种治疗算法,将denosumab定位为其他局部治疗后的可行治疗选择。精心挑选病人,监测,需要进一步的研究来优化denosumab在ABCs中的使用。
Background/Objective: Surgical treatment of aneurysmal bone cysts (ABCs) can be challenging, especially in the spine. Non-surgical treatments such as with denosumab have shown promising results in different osteolytic pathologies. This retrospective observational study aimed to evaluate the long-term clinical and radiologic response of patients with ABCs of the mobile spine treated with denosumab and propose an updated treatment algorithm. Methods: Six patients with relapsed and symptomatic ABCs of the mobile spine were treated with denosumab (120 mg subcutaneously on days 1, 8, 15, 29, and every 4 weeks thereafter) between 2012 and 2023. Disease assessments were conducted using CT and MRI at 3, 6, 9, and 12 months post-treatment. Clinical data, including pain levels, symptoms, and adverse events, were documented from patients\' charts. Results: Patients underwent an initial phase of treatment with denosumab, receiving a mean of 22 administrations (range 13-42) over a median follow-up period of 41 months (range 15-98 months). Clinical improvement was observed in all patients after 4 weeks of treatment, and all patients demonstrated a radiological response after 12-24 weeks on denosumab. Three patients were progression-free after discontinuing denosumab following 13, 15, and 42 administrations, respectively. At the last follow-up, after 38, 43, and 98 months, these patients remained stable without relapse of the disease. Three patients had a relapse of disease after denosumab; two of them underwent denosumab re-challenge, while one patient received one mesenchymal stem cells (MSCs) injection. All patients showed clinical and radiological improvement and were resulted to be disease-free at the last follow-up. Conclusions: This study demonstrates the long-term efficacy and safety of denosumab in treating ABCs of the mobile spine, as well as the potential of re-challenge in managing recurrence. A treatment algorithm is proposed, positioning denosumab as a viable therapeutic option after other local treatments. Careful patient selection, monitoring, and further research are necessary to optimize denosumab use for ABCs.