Background: Aneurysmal bone cysts (ABCs) are rare, benign, but potentially aggressive bone lesions, particularly challenging when located in the spine. Recurrent ABCs in pediatric patients present significant therapeutic dilemmas, especially after incomplete surgical resections. Case Description: We report the case of a 6-year-old girl, previously treated for medulloblastoma, who developed a recurrent spinal ABC at the L1 vertebral level. Despite undergoing two incomplete resections due to the lesion’s location and involvement of critical structures, recurrence was observed. Given the elevated surgical risk and tumor persistence, off-label denosumab therapy was initiated. After 12 months of monthly administration, the patient demonstrated clinical improvement, radiological stability, and no reported adverse effects. Conclusion: This case highlights the potential role of denosumab as an adjuvant treatment option for recurrent spinal ABCs when complete surgical resection is not feasible. While promising, further studies are warranted to define optimal dosing, treatment duration, and long-term safety in pediatric patients.
Melo et al. (Fri,) studied this question.