Management of aneurysmal bone cysts of the spine and sacrum: A narrative review.

This narrative review summarizes contemporary diagnosis and management of aneurysmal bone cysts (ABCs) of the spine and sacrum, emphasizing axial-specific risks, decision thresholds, and adjunctive therapies. A PubMed/MEDLINE review was performed focusing on the last 10 years, with selective inclusion of earlier foundational studies. Search terms combined "aneurysmal bone cyst" with anatomy-specific modifiers ("spine," "vertebral," and "sacrum") and domains relevant to axial care, including molecular diagnostics such as ubiquitin-specific peptidase 6, imaging, biopsy, differential diagnosis, operative strategies, embolization, percutaneous therapies, and recurrence. ABCs are benign but locally aggressive lesions that frequently involve posterior elements, extend toward the canal, and threaten neurologic function and stability. Imaging may demonstrate expansile osteolysis and fluid-fluid levels but lacks specificity in axial disease; biopsy remains essential to exclude malignant mimics and secondary ABC-like change. Management is individualized based on neurologic compromise, instability, deformity, and lesion extent. Surgical options range from intralesional curettage to more extensive excision with stabilization, while adjuncts such as selective arterial embolization, doxycycline sclerotherapy, and denosumab may support hemorrhage control and local control in selected cases. Recurrence remains most strongly associated with incomplete resection and younger age. Prospective, spine-specific comparative studies are needed to standardize treatment selection, define the sequencing of adjuncts, and clarify long-term outcomes.