# Viscosity-Augmented Percutaneous Sclerotherapy for Recurrent Thoracic Spinal Aneurysmal Bone Cyst: A Technical Innovation to Mitigate Venous Washout

## TL;DR

A new injection technique improved treatment of a recurring spinal bone cyst by reducing venous washout and promoting healing.

## Contribution

A thickened sclerosant mixture was introduced to reduce rapid washout during percutaneous sclerotherapy for aneurysmal bone cyst recurrence.

## Key findings

- A thick sclerosant mixture reduced venous washout and improved treatment outcomes in a recurrent thoracic spinal ABC.
- The modified technique led to new bone formation and stabilization of the lesion over two years.
- The technique is easy to reproduce and based on logical problem-solving in interventional radiology.

## Abstract

A 27-year-old male was operated on for a thoracic seven-vertebra aneurysmal bone cyst (ABC). On the six-year follow-up, he had radiological signs of recurrence. Treatment plan for recurrence was multiple sessions of percutaneous intralesional sclerotherapy with 3% of sodium tetradecyl sulphate (STS). The remarkable vascularity of the lesion resulted in rapid washout of the sclerosant mixture. Henceforth, an improvised technique was used in the third attempt. A thick sclerosant mixture injectate consisting of 3 ml of 3% STS mixed with 2 ml of gelatin sponge slurry (EG Gel 350-650 micron) and 2 ml of computed tomography (CT) contrast was used. At the six-month follow-up, there was new bone formation along the margins of the lytic lesion. The patient received two more sessions of the same injectate. At the two-year follow-up, the lesion showed no expansion of the lytic area with further increase in sclerosis. Modification of the injection technique with the use of a thick sclerosant mixture reduced the washout time. This case report describes the easy reproducibility of the technique and the simple logical problem-solving method, which is fundamental to Interventional radiology.