Vertebral remodeling in eosinophilic granuloma of the spine. A long-term follow-up.

STUDY

DESIGN

In this study, 14 conservatively treated patients were reviewed who had eosinophilic granuloma of the spine, which had been diagnosed on the basis of histologic study of the vertebral lesion or of specimens from other sites in patients with multiple involvement. The remodeling of the vertebral body was studied in an average follow-up of 5.6 years.

OBJECTIVES

To analyze the remodeling process of the involved growing vertebral body in Langerhans Cell Histiocytosis after conservative treatment and to assess the sagittal and frontal profile of the spine at the end of growth. Fourteen patients, aged between 1.2 and 11.3 years, with spinal involvement of a Langerhans' cell histiocytosis were treated in the department of orthopedics between 1980 and 1990. All patients had immobilization of the affected region by a custom-made brace. Six patients with symptomatic lesions had radiotherapy and four patients with disseminated disease were treated with chemotherapy. Clinical and radiologic examinations were made at regular intervals to evaluate the development of the vertebrae during the remodeling process.

SUMMARY OF BACKGROUND DATA: In the 14 patients, both sexes were affected equally. The disease was located in the cervical spine in two patients and in thoracic and lumbar vertebrae in seven patients each. Two patients had two vertebral lesions.

METHODS

The radiologic evolution of the 16 vertebral lesions was evaluated using follow-up standardized lateral radiographs. The reconstitution of the vertebral height in the presence of vertebra plana was calculated by measuring the ventral distance between the superior and inferior margins of the vertebral body in relation to the adjacent uninvolved vertebra.

RESULTS

The measurements showed a growth rate of 1.5-6 (average, 3) in vertebrae with vertebra plana and a growth rate of 1.1-2.7 (average, 1.4) in the unaffected vertebra. The reconstitution of the vertebral height was between 18.2% and 63.8% of the adjacent vertebrae before and between 72.2% and 97% after skeletal maturity.

CONCLUSIONS

The results demonstrate that conservative orthopedic treatment with immobilization in a brace is sufficient to allow for optimal vertebral remodeling. Partial to nearly complete reconstitution of vertebral height was seen in all cases. Thus, operative treatment with curettage of the lesion and bone grafting including multisegmental fusion with instrumentation is not necessary. In instances with neurologic impairment, rarely seen in adults, surgical decompression and short fusion of the spine is necessary. Nevertheless, complete staging and biopsy are mandatory for an accurate diagnosis.