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Angelini A, Mosele N, Gnassi A, Baracco R, Rodà MG, Cerchiaro M, Ruggieri P. Vertebra Plana: A Narrative Clinical and Imaging Overview among Possible Differential Diagnoses. Diagnostics (Basel) 2023; 13:diagnostics13081438. [PMID: 37189540 DOI: 10.3390/diagnostics13081438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
Vertebra plana is a rare radiologic condition characterized by a uniform loss of height of a vertebral body that represents a diagnostic challenge for surgeons. The purpose of this study was to review all possible differential diagnoses that may present with a vertebra plana (VP) described in the current literature. For that purpose, we performed a narrative literature review in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, analyzing 602 articles. Patient demographics, clinical presentation, imaging characteristics and diagnoses were investigated. VP is not a pathognomonic feature of Langerhans cell histiocytosis, but other oncologic and non-oncologic conditions should be considered. The list of differential diagnoses, based on our literature review, can be recalled with the mnemonic HEIGHT OF HOMO: H-Histiocytosis; E-Ewing's sarcoma; I-Infection; G-Giant cell tumor; H-Hematologic neoplasms; T-Tuberculosis; O-Osteogenesis imperfecta; F-Fracture; H-Hemangioma; O-Osteoblastoma; M-Metastasis; O-Osteomyelitis, chronic.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Nicolò Mosele
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Andrea Gnassi
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Riccardo Baracco
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Maria Grazia Rodà
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Mariachiara Cerchiaro
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
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Histiocytosis in the pediatric spine: a clinical and radiographic analysis of 50 patients. Spine Deform 2021; 9:823-831. [PMID: 33400235 DOI: 10.1007/s43390-020-00261-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
STUDY DESIGN Descriptive, retrospective. Scientific level of evidence IV. OBJECTIVES The aim of this study was to evaluate a consecutive case series of 50 pediatric patients with LCH of the spine. Langerhans cell histiocytosis (LCH) is a rare disease characterized by abnormal proliferation of Langerhans cells in different organs. Incidence in children range from 2 to 10 cases per million. In the current literature, few series evaluate LCH in the pediatric spine. MATERIAL AND METHODS A consecutive case series of 50 pediatric patients with LCH of the spine treated at our hospital between 1984 and 2016, with a follow-up of at least 2 years, was analyzed. Sex, age, clinical and radiographic presentation, number of lesions, treatment, complications, and outcome were assessed. RESULTS Fifty patients, 26 boys and 24 girls, were evaluated. Mean age was 5 years and 2 months (6 months to 13 years and 3 months). 27 patients had a single spinal lesion while 23 had 2 or more lesions. A total of 100 vertebrae were involved. The thoracic spine was the most affected. The most frequent lesion location was in the vertebral body in 88% of the cases. The symptoms were pain (87%), reduced range of motion, deformity, and neurologic deficit. Biopsy was performed in 48 patients. Thirty-nine patients received medical treatment, 28 used orthoses and six required surgery. Six patients (12%) recurred at a mean of 3 years and 5 months (range 2-12 years). In all cases, neurological symptoms, torticollis, and deformities resolved after medical or surgical treatment. CONCLUSIONS Because of the variable presentation of the disease, ranging from a solitary isolated vertebral lesion to polyostotic and multisystemic involvement, a multidisciplinary team is required to have an adequate management of these patients and to obtain good results.
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Roberts SB, Calligeros K, Tsirikos AI. Evaluation and management of paediatric and adolescent back pain: Epidemiology, presentation, investigation, and clinical management: A narrative review. J Back Musculoskelet Rehabil 2020; 32:955-988. [PMID: 31524137 DOI: 10.3233/bmr-170987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This narrative review will summarise a clinical approach to the investigation of back pain in children and adolescent patients, including a discussion of the epidemiology, presentation, investigation and clinical management of back pain in children and adolescents. This will assist the prompt and accurate diagnosis of spinal disorders that require significant medical intervention. Existing evidence suggests a relatively high incidence of non-specific back pain among young people; 27-48% of presentations of back pain in children and adolescents are attributed to non-specific back pain. Low back pain among schoolchildren is often linked to psychosocial factors and only occasionally requires medical attention, as pain is benign and self-limiting. Nonetheless, those young patients who seek medical assistance exhibit a higher incidence of organic conditions underlying the major symptom of spinal pain. A cautious and comprehensive strategy - including a detailed history, examination, radiographic imaging and diagnostic laboratory studies - should be employed, which must be accurate, reliable, consistent and reproducible in identifying spinal pathologies. A specific diagnosis can be reached in 52-73% of the cases. For cases in which a specific diagnosis cannot be made, re-evaluation after a period of observation is recommended. At this later stage, minor symptoms unrelated to underlying pathology will resolve spontaneously, whereas serious pathologies will advance and become easily identified.
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Langerhans' cell histiocytosis in the pediatric spine: therapeutic dynamic change of spinal deformity. Childs Nerv Syst 2012; 28:1243-50. [PMID: 22543433 DOI: 10.1007/s00381-012-1764-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 04/10/2012] [Indexed: 12/25/2022]
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Abstract
STUDY DESIGN A case report and literature review. OBJECTIVE To illustrate the spontaneous resolution of unstable pathological fracture of the odontoid process of the C2 caused by Langerhans cell histiocytosis (LCH) in early childhood. SUMMARY OF BACKGROUND DATA The involvement of atlantoaxial LCH is very rare and its treatment is unfamiliar to surgeons. Therefore, the management of pediatric LCH of the odontoid process and the C2 body is challenging and must be adapted according to the patient's needs; it could range from observation to surgical intervention. METHODS A case of pathological fracture of the odontoid process with torticollis diagnosed with LCH of the odontoid process and C2 body and involving right femur in early childhood is presented. A histopathological study showed LCH. The patient underwent brace immobilization and systemic chemotherapy. RESULTS The patient showed successful bony remodeling without LCH recurrence on CT. The neck pain was resolved, and there was no limitation in neck movement. CONCLUSION Immobilization and systemic chemotherapy with close observation are adequate for the management of patients despite the unstable pathological fracture of the odontoid process.
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Greenleaf RM, Ricciardella LF, Latona CR, Sangimino MJ. Vertebra plana in an adolescent caused by multiple myeloma: a case report and review of the literature. J Bone Joint Surg Am 2011; 93:e37. [PMID: 21508272 DOI: 10.2106/jbjs.j.00640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Robert M Greenleaf
- Allegheny General Hospital, 1307 Federal Street, 2nd floor, Pittsburgh, PA 15212, USA.
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Eosinophilic granuloma of spine in adults: a report of 30 cases and outcome. Acta Neurochir (Wien) 2010; 152:1129-37. [PMID: 20396916 DOI: 10.1007/s00701-010-0644-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 03/17/2010] [Indexed: 12/28/2022]
Abstract
BACKGROUND Eosinophilic granuloma (EG) of the spine is rare, especially in adults. There had been few large and long-term studies reported in the literature. The management goals of this disease in adults are preservation of neurologic function, relief of pain and reconstruction of spinal stability. However, there are still controversies over appropriate management modality of eosinophilic granuloma. METHODS Clinical manifestations, radiographic presentations, therapeutic outcomes and follow-up findings of 30 adults who were histiologically diagnosed with spinal eosinophilic granuloma, including 28 patients who received surgical treatment at our institutions from 1985 to 2008 were reviewed retrospectively. RESULTS There were 25 males and five females with a mean age of 34.5 years (range, 18-71 years). The post-operative follow-up period ranged from 2 to 22.4 years (mean, 8.3 years). Neurologic deficits developed in 21 patients, apparent kyphosis developed in four cases. In contrast to the classic feature of vertebra plana in children, we found that more severe lesions often led to asymmetric collapse in adult patients and only three patients presented with vertebra plana. Thirty-three vertebral lesions distributed throughout the spine column. Twenty-one lesions were in cervical spine, seven in the thoracic spine and five in the lumbar spine. Twenty-eight adult patients underwent surgical resection with or without chemotherapy or radiotherapy, and four (13.3%) patients had recurrence after surgery. No patient in our series died. CONCLUSIONS The onset of spinal EG is insidious and mainly presents as osteolytic destruction. There is a particular high prevalence of lesions in the cervical spine and more severe lesions often led to asymmetric collapse. As the skeleton of adults is well-developed and the epiphysis has stopped growing, individualized management including surgical intervention should be considered in adult patients with spinal EG who present with neurological damage and spinal instability.
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Ippolito E, Versari P, Lezzerini S. The role of rehabilitation in juvenile low back disorders. ACTA ACUST UNITED AC 2009; 9:174-84. [PMID: 17050395 DOI: 10.1080/13638490500158031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Both children and adolescents are frequently affected by low back pain--mainly when they are involved in sporting activities--but they rarely ask for medical help, because their symptoms are often mild and self-resolving. However, in the young patients who seek orthopaedic evaluation, especially in referral centres, there is a high incidence of organic causes of their back pain. Mechanical, developmental, inflammatory and tumoural or tumour-like disorders are the most frequent aetiologic factors. A diagnosis of psychosomatic back pain should be made only when all the other possible organic causes have been excluded. Rehabilitation is part of the treatment of low back disorders in children and adolescents. Postural low back pain is likely to be resolved by physical therapy alone. In other disorders that initially require medical, orthotic or surgical treatment, rehabilitation plays an important role either in combination with them or as a subsequent treatment.
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Affiliation(s)
- E Ippolito
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, Roma, Italy.
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Greenlee JDW, Fenoy AJ, Donovan KA, Menezes AH. Eosinophilic granuloma in the pediatric spine. Pediatr Neurosurg 2007; 43:285-92. [PMID: 17627144 DOI: 10.1159/000103308] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Accepted: 11/30/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Eosinophilic granuloma (EG) involving the vertebrae in the pediatric population presents a difficult management scenario. Issues of surgical versus nonsurgical intervention, spinal stability and continued skeletal growth must all be considered. METHODS A retrospective review of medical records and radiographs from 1964 to the present yielded 12 patients with age less than 18 at the time of diagnosis of primary spinal EG. RESULTS Eleven of these 12 patients presented with pain; 2 patients had neurological deficits. Nine patients were managed nonsurgically, including those undergoing tissue diagnosis by needle (2) or extraspinal (3) biopsy; 3 patients underwent gross total resections. Radiographic diagnosis alone was made in 4. With an average follow-up of 8.1 years, survival is 100%. CONCLUSIONS EG in the spine infrequently produces neurological deficits in the pediatric age group, although it may result in spinal instability. As such, nonsurgical management is the preferred strategy to effect symptomatic relief.
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Affiliation(s)
- Jeremy D W Greenlee
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
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Shisha T, Kiss S, Varga PP, Bucsi L, Pap K, Szoke G. Osteochondritis (Calvé's disease) of a vertebral body--a rare form of vertebra plana. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2005; 15:377-83. [PMID: 16133082 PMCID: PMC3489296 DOI: 10.1007/s00586-005-1007-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Revised: 05/13/2005] [Accepted: 07/10/2005] [Indexed: 10/25/2022]
Abstract
In 1925, Calvé described vertebra plana as an aseptic necrosis of bone involving a single vertebral body of the spinal column. This theory was set aside in 1954 by Compere, who concluded that vertebra plana is caused by eosinophilic granuloma and not by osteochondritis as suggested by Calvé. It has been well documented in literature that many factors other than eosinophilic granuloma can cause vertebra plana-like destruction of the vertebral body. However, the definition of the terms was not clear, and there was no consensus on whether to call these cases vertebra plana or not. Some authors did, some did not. Anyhow, no publication so far has reported on osteochondritis as a rare cause of vertebra plana. The case of a 12-year-old girl, presented here by the authors, suggests this explanation. Some important conclusions can be drawn from this regarding the nomenclature, the diagnosis, and the therapy.
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Affiliation(s)
- Tamas Shisha
- Semmelweis University, Orthopaedic surgery, Budapest, Hungary.
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Abstract
The most common lumbar spine tumors are metastatic disease, myeloma, and hemangioma. Primary osseous lesions of the lumbar spine are unusual. When encountered, they often exhibit characteristic imaging properties, aiding the radiologist to provide a short list of differential diagnoses. We provide a discussion of imaging appearance of lumbar spine neoplasms. Emphasis of this review is on osseous lesions. Few common neurogenic intradural, extraaxial lesions are also discussed.
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Affiliation(s)
- Kambiz Motamedi
- Section of Musculoskeletal Imaging, Department of Radiology, David Gef-fen School of Medicine at UCLA, Los Angeles, CA 90095-6952, USA.
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Abstract
STUDY DESIGN A meta-analysis was performed based on 53 cases of cervical eosinophilic granuloma reported in the literature and 1 in an adult treated by the authors. OBJECTIVE To stress the clinical and radiologic differences between cervical and thoracolumbar spinal eosinophilic granuloma and to point out differences between adults and children with cervical eosinophilic granuloma to avoid false diagnosis. SUMMARY OF BACKGROUND DATA Until now, cervical eosinophilic granuloma has been reported in 43 children and 9 adults. In 1 case the age is unknown. In previous studies, differences between adults and children with cervical eosinophilic granuloma have not been analyzed, nor has cervical eosinophilic granuloma been compared with thoracolumbar eosinophilic granuloma. METHODS All reported cases of cervical eosinophilic granuloma were analyzed concerning age and sex distribution, clinical and radiologic presentation, therapy, and outcome. The authors' case in a 46-year-old patient is discussed. RESULTS The presenting symptoms of cervical eosinophilic granuloma are usually pain and restricted range of motion. In contrast to eosinophilic granuloma of the thoracic spine and lumbar spine, the neurologic symptoms are less frequent, and the first radiographic sign is an osteolytic lesion. Vertebra plana is a rare sign in cervical eosinophilic granuloma. In children, the middle cervical spine is most often affected, whereas in adults it is the second vertebra. The outcome of the patients has been good in most cases, independently of treatment. CONCLUSION In most cases of cervical eosinophilic granuloma, immobilization is an adequate therapy. If the process continuous to progress, radiotherapy is recommended. Surgical treatment should be reserved for cases with instability or neurologic defects.
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Affiliation(s)
- Christoph Bertram
- Department of Traumatology, Allgemeines Krankenhaus St. Georg, Hamburg, Germany.
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Papagelopoulos PJ, Currier BL, Galanis E, Grubb MJ, Pritchard DJ, Ebersold MJ. Vertebra plana caused by primary Ewing sarcoma: case report and review of the literature. JOURNAL OF SPINAL DISORDERS & TECHNIQUES 2002; 15:252-7. [PMID: 12131429 DOI: 10.1097/00024720-200206000-00015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 7-year-old boy presented with vertebra plana of T11. The presumptive diagnosis suggested by clinical presentation, conventional radiographs, and computed tomographic scans was eosinophilic granuloma. Progressive neurologic symptoms required surgical excision of the lesion and decompression. Histopathologic examination of the surgical specimen confirmed the diagnosis of Ewing sarcoma.
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Affiliation(s)
- Panayiotis J Papagelopoulos
- Department of Orthopedic Surgery, Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, U.S.A
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Emir S, Akyüz C, Yazici M, Büyükpamukçu M. Vertebra plana as a manifestation of Ewing sarcoma in a child. MEDICAL AND PEDIATRIC ONCOLOGY 1999; 33:594-5. [PMID: 10573589 DOI: 10.1002/(sici)1096-911x(199912)33:6<594::aid-mpo16>3.0.co;2-n] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Yeom JS, Lee CK, Shin HY, Lee CS, Han CS, Chang H. Langerhans' cell histiocytosis of the spine. Analysis of twenty-three cases. Spine (Phila Pa 1976) 1999; 24:1740-9. [PMID: 10472109 DOI: 10.1097/00007632-199908150-00016] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of clinical and radiologic data in four major tertiary referral centers. OBJECTIVES To report clinical and roentgenographic findings, to evaluate the results of various treatment methods, and to propose a protocol for management. SUMMARY OF BACKGROUND DATA Langerhans' cell histiocytosis of the spine is a rare condition, and therefore, appropriate management is still controversial. METHODS Clinical and roentgenographic findings of 38 vertebral lesions of 23 children, with average follow-up of 5.4 years, were investigated. This is the most extensive report apparent in the literature to date. The results of treatment were assessed clinically and radiologically. Anterior vertebral body height was measured sequentially to evaluate reconstitution of the vertebral body. RESULTS The last follow-up examination demonstrated no clinical evidence of disease in all patients, regardless of treatment method. Neurologic deficits developed in four patients, but they completely disappeared. Satisfactory restoration of height was demonstrated in all except five vertebrae: one that had collapsed maximally when the patient was more than 15 years of age and four that had been fused anteriorly or posteriorly. Unsatisfactory results were also seen in a patient with progressive scoliosis and in one with an irregular endplate with disc space narrowing. Both of these complications developed after curettage. CONCLUSIONS For treatment of single or dual spinal lesions, observation with or without bracing seems to be sufficient. In patients with multifocal lesions, chemotherapy produces good results. For treatment of neurologic deficit, low-dose radiotherapy is favored. Patients who underwent surgery--especially curettage and anterior fusion--had the worst outcome.
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Affiliation(s)
- J S Yeom
- Department of Orthopaedic Surgery, Seoul National University Hospital, Korea
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Kager L, Zoubek A, Kotz R, Amann G, Wiesbauer P, Dobrowsky W, Gadner H. Vertebra plana due to a Ewing tumor. MEDICAL AND PEDIATRIC ONCOLOGY 1999; 32:57-9. [PMID: 9917755 DOI: 10.1002/(sici)1096-911x(199901)32:1<57::aid-mpo12>3.0.co;2-j] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- L Kager
- St. Anna Children's Hospital, Vienna, Austria
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Abstract
Between May 1972 and December 1991, 58 children were seen in the authors' institution for treatment of Langerhans' cell histiocytosis. Of these, 15 children (7 males, 8 females) had biopsy-proven Langerhans' cell histiocytosis with vertebral involvement. The average age at presentation was 6.4 years (range, 0.2-13.3 years). At presentation, 8 patients had involvement of a single vertebra and 4 had involvement of multiple vertebrae. Nine patients had extraspinal skeletal involvement. Two patients had visceral involvement. Currently, 13 patients have had >2 years followup (average, 8.9 years; range, 2-21 years). None of these patients had clinical evidence of disease at the latest encounter. This group of patients with Langerhans' cell histiocytosis with vertebral involvement has fared well. Most patients have had involvement of multiple vertebrae and many have had extraspinal bony involvement as well. There was a great deal of variability in the extent of collapse and reconstitution of vertebral height, and the amount of reconstitution did not correlate with patient age.
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Affiliation(s)
- S E Levine
- Department of Orthopaedic Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
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Abstract
The case of a 9-year-old boy presenting with a vertebra plana at T7 is reported. The initial diagnosis, as suggested by clinical presentation, conventional radiographs and CT scans, was eosinophilic granuloma. Positive radionuclide bone scan led to biopsy of the posterior arch, which suggested giant cell tumour. MRI showed extraspinal tumour involvement. Vertebrectomy revealed osteosarcoma.
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Affiliation(s)
- M Baghaie
- Department of Medical Imaging, University Hospital Sart Tilman, B-4000 Liege 1, Belgium
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Bilge T, Barut S, Yaymaci Y, Alatli C. Solitary eosinophilic granuloma of the lumbar spine in an adult. Case report. PARAPLEGIA 1995; 33:485-7. [PMID: 7478747 DOI: 10.1038/sc.1995.107] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Eosinophilic granuloma of bone is the localised and most benign form of Langerhans-cell histiocytosis, previously known as histiocytosis X and is characterised by lytic lesions of one or more bones. It is a disease of children and adolescents, and very rarely affects adults. We report a 34-year-old patient with a solitary eosinophilic granuloma involving the fifth lumbar vertebra which produced sciatica. Operative treatment performed by a single extended posterior approach consisted of total resection of the tumour with hemicorporectomy, L4-5 and L5-S1 discectomy, interbody fusion with an iliac bone graft, and interpedicular fixation. Postoperatively, the symptoms resolved and the patient continues to do well at 2 1/2 years follow-up.
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Affiliation(s)
- T Bilge
- Department of Neurosurgery, Taksim Hospital, Istanbul, Turkey
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Abstract
A case of a 14-year-old boy with a solitary eosinophilic granuloma of the thoracic spine, with paraplegia secondary to the collapse of the vertebra and peridural spread of tumor, is presented. It is the 14th case recorded in literature to this date. This disease is self-limiting, and there is no role of steroids or radiotherapy observed.
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Affiliation(s)
- A Kumar
- Department of Orthopedics and Trauma, Muhimbili Medical Center, Dar Es Salaam, Tanzania
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Thommesen P, Bartholdy N, Friis Andersen MJ. Histiocytosis X. IX. Fine needle aspiration biopsy for differentiation between histiocytosis X and spondylitis. ACTA RADIOLOGICA. ONCOLOGY 1983; 22:349-51. [PMID: 6320592 DOI: 10.3109/02841868309134052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Fine needle aspiration biopsy was carried out in 35 patients with vertebral lesions in an attempt to differentiate between histiocytosis X and spondylitis. In 7 patients (6 with histiocytosis X and 1 with carcinoma) aspiration biopsy was of decisive diagnostic value. In 26 cases aspiration biopsy supported the diagnosis of spondylitis and in 2 patients no diagnostic information was obtained by aspiration biopsy. In selected cases of bone lesions in the spine, fine needle aspiration biopsy is recommended as an easy and important diagnostic procedure.
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Thommesen P, Bartholdy N, Bünger E. Histiocytosis X. VIII. Histiocytosis X simulating tuberculosis. ACTA RADIOLOGICA. ONCOLOGY 1983; 22:295-7. [PMID: 6316751 DOI: 10.3109/02841868309134044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The findings in 9 patients with histiocytosis X localized to the spine and 7 patients with tuberculous spondylitis were compared. It was not always possible to differentiate between these two conditions without a supplementary fine needle aspiration biopsy. This is therefore recommended in patients with possible histiocytosis X or spondylitis and a divergent clinical course.
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Solgaard S, Kristiansen B. Vertebra plana due to a malignant lymphoma. ACTA ORTHOPAEDICA SCANDINAVICA 1980; 51:267-9. [PMID: 7435185 DOI: 10.3109/17453678008990797] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A patient with total collapse of the vertebral bodies ("vertebra plana") is described. The symptoms and objective findings were caused by a malignant lymphoma, and the diagnosis was established from a drill biopsy. It is recommended that a biopsy be performed in patients with "vertebra plana".
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Thommesen P, Poulsen JO. Primary tumours in the spine and pelvis in adolescents: clinical and radiological features. ACTA ORTHOPAEDICA SCANDINAVICA 1976; 47:170-4. [PMID: 1274539 DOI: 10.3109/17453677608989713] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In 34 patients in their two first decades of life with primary bone tumours in the spine and pelvis, the most common benign tumour was histiocytosis X and the most common malignant tumour, Ewing's sarcoma. X-rays were positive in 32 out of 34 cases but of little diagnostic value and primary complaints were without significance. The final diagnosis can only be made after a biopsy.
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Poulsen JO, Thommesen P. An unusual case of histiocytosis X in the spine. ACTA ORTHOPAEDICA SCANDINAVICA 1976; 47:59-62. [PMID: 1083620 DOI: 10.3109/17453677608998973] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A case of spontaneously healing histiocytosis X followed over 9 years is presented. The lesion was located in the cervical and dorsal spine and had unusual radiological features such as soft tissue swelling, involvement of the pedicles and recovery with fusion between adjacent vertebra.
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