Imaging Analysis Report

1. Radiological Findings

Based on the provided images (MRI, CT, etc.), the following observations can be noted:

• The lesion is located in the upper cervical spine (suspected around the C2 vertebra or adjacent vertebral body) and shows significant expansile osteolytic changes.
• On MRI, it appears as a multiloculated cystic lesion. T2-weighted images show high signal intensity, and in some slices, there may be a “fluid-fluid level.”
• On CT, there is a decrease in local bone density, presenting with a “bubble-like” or “soap-bubble” appearance, and the edges may exhibit a certain degree of sclerosis.
• No significant obvious soft tissue swelling or mass is noted in the adjacent soft tissues, and there is currently no clear evidence of soft tissue invasion.
• The overall cervical spine alignment appears largely preserved, with no clear fracture lines or vertebral collapse. Although the lesion is expansile, there is no obvious sign of nerve compression.

2. Potential Diagnosis

Considering the patient’s age (6 years old), clinical presentation (neck pain but no evident neurological deficits), and imaging findings (expansile osteolytic lesion, cystic changes, possible fluid-fluid levels), the differential diagnoses include:

1. Aneurysmal Bone Cyst (ABC)
   This condition commonly occurs in children and adolescents, often featuring rapid growth, cystic or “bubble-like” expansile lesions, and fluid-fluid levels. It closely matches the imaging characteristics presented.
2. Giant Cell Tumor (GCT)
   More commonly seen in young adults post-epiphyseal closure, and less frequently in the cervical spine. However, there are occasional pediatric reports. The imaging findings can overlap with those of ABC and require pathological correlation to differentiate.
3. Telangiectatic Osteosarcoma
   This malignant tumor can present with cystic changes and fluid-fluid levels similar to ABC. However, it often shows more aggressive or destructive features, and a malignancy should be ruled out via pathological examination.

3. Final Diagnosis

Given the patient’s young age (6 years), the expansile and cystic nature of the lesion, and the absence of overt malignant features (such as extensive soft tissue invasion and widespread bone destruction), the most likely diagnosis is Aneurysmal Bone Cyst (ABC). If there is any uncertainty, further pathological evaluation (e.g., biopsy or intraoperative frozen section) is needed to rule out rare malignant lesions (such as telangiectatic osteosarcoma).

4. Treatment Plan and Rehabilitation

Treatment Strategy Overview:

• Conservative Management: If the lesion does not cause spinal instability or neurological deficits, short-term observation under medical supervision and a cervical collar may reduce pain during movement. However, given the rapid expansion in children, surgical evaluation is often required.
• Surgical Intervention: Common procedures include curettage of the lesion, bone grafting, and possibly internal fixation to prevent spinal instability or subsequent deformities. For extensive lesions, staged procedures or wider resection may be necessary.
• Interventional Therapy: In some cases, preoperative embolization can be considered to reduce intraoperative bleeding. However, this depends on the lesion’s location and vascular supply.

Rehabilitation/Exercise Prescription (FITT-VP principle):

• Early Phase (Postoperative or Early Conservative Management)
  Frequency: 3-5 times per week, focusing on gentle neck movements and protection of cervical and shoulder muscles.
  Intensity: Low, avoiding excessive rotation or hyperextension of the neck.
  Time: 10-15 minutes per session of mild activities such as gentle neck joint movement and shoulder rolls.
  Type: Primarily posture correction, posture maintenance drills, mild stretching, and isometric strength exercises.
  Progression: Gradually increase the range of motion and subtle resistance training as tolerated.
• Mid Phase (When Condition Stabilizes)
  Frequency: Maintain 3-5 times per week, potentially increasing the variety of exercises (e.g., Pilates, core stability training).
  Intensity: Low to moderate, slowly introducing increased resistance for neck and shoulder girdle muscle strengthening under professional guidance.
  Time: 20-30 minutes per session, possibly divided into sets (e.g., group-based core stability exercises combined with stretching).
  Type: Continue ensuring neck stability and correct posture. Low-impact aerobic exercises (e.g., stationary cycling) can be added.
  Progression: If tolerated well, introduce light resistance exercises, such as resistance bands or light dumbbells, while avoiding excessive cervical loading.
• Late Phase (Recovery or Consolidation)
  Frequency: 3-5 times per week for long-term posture and muscular reinforcement.
  Intensity: May be increased to moderate based on individual progress, still avoiding sudden high-impact or extreme neck movements.
  Time: 30-45 minutes per session, emphasizing core and upper limb stability exercises.
  Type: Activities such as swimming (breaststroke, freestyle without extreme cervical extension), light strength training, and continued core stability drills.
  Progression: Gradually resume normal activities and sports if pain-free, with regular follow-up to assess cervical spine stability and muscle strength.

Throughout the rehabilitation process, closely monitor the child’s pain and any signs of discomfort. If neck pain worsens significantly, or if there is numbness in the upper limbs or any new neurological symptoms, seek medical evaluation promptly and adjust the exercise program accordingly.

Disclaimer: This report provides a reference-based analysis using the current imaging and medical history. It does not replace in-person consultation or professional medical advice. In the event of any concerns or changes in the condition, promptly seek evaluation at a certified healthcare facility.