OBJECTIVE: To emphasize the importance of early detection, recognition, appropriate investigation, accurate diagnosis, proper referral, and treatment of an aneurysmal bone cyst (ABC) presenting as chronic low back pain (LBP) in a chiropractic office. CLINICAL FEATURES: A 21-year-old female student presented to the chiropractic office with a 2-year history of severe and progressive LBP. The patient described the LBP as an aching type of pain that was more pronounced during activity and exercises. She also reported weight loss and increased fatigue. INTERVENTION AND OUTCOME: A detailed clinical, physical, and imaging evaluation was performed. A well-defined, expansile, and lytic bone lesion with the appearance of a possible ABC was detected; it involved the left inferior half and posterolateral aspect of the vertebral body of L3. RESULTS: Treatment consisted of an L3 hemivertebrectomy resection en bloc and a vertebral fusion from L2 to L4 with tricortical iliac crest graft. After surgery and recovery, LBP was relieved and the bone lesion did not recur. CONCLUSION: Although uncommon, ABC is an important lesion that can affect the spine. Healthcare providers must be aware that the cause of LBP may extend beyond musculoskeletal dysfunction. It is important to identify an ABC and refer the patient for appropriate evaluation and care.
OBJECTIVE: To emphasize the importance of early detection, recognition, appropriate investigation, accurate diagnosis, proper referral, and treatment of an aneurysmal bone cyst (ABC) presenting as chronic low back pain (LBP) in a chiropractic office. CLINICAL FEATURES: A 21-year-old female student presented to the chiropractic office with a 2-year history of severe and progressive LBP. The patient described the LBP as an aching type of pain that was more pronounced during activity and exercises. She also reported weight loss and increased fatigue. INTERVENTION AND OUTCOME: A detailed clinical, physical, and imaging evaluation was performed. A well-defined, expansile, and lytic bone lesion with the appearance of a possible ABC was detected; it involved the left inferior half and posterolateral aspect of the vertebral body of L3. RESULTS: Treatment consisted of an L3 hemivertebrectomy resection en bloc and a vertebral fusion from L2 to L4 with tricortical iliac crest graft. After surgery and recovery, LBP was relieved and the bone lesion did not recur. CONCLUSION: Although uncommon, ABC is an important lesion that can affect the spine. Healthcare providers must be aware that the cause of LBP may extend beyond musculoskeletal dysfunction. It is important to identify an ABC and refer the patient for appropriate evaluation and care.