Eosinophilic Granuloma of the Spine

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- See: Eosinophilic Granuloma - Discussion:

- Discussion:
    - most common in the thoracic spine;
    - may present with progressive back pain;
    - vertebra plana:
          - in 2-6 yrs old child, EOG may present w/ collapse of single vertebra;
          - diff dx of single level collapse:    
                  - ewing's sarcoma;
                  - ABC
                  - osteomyelitis (look for loss of disc height);
          - ref: Vertebra plana of the lumbar spine caused by an ABC: a case report.
                      PJ Papagelopoulos MD et al.   The American Journal of Orthopedics. Feb 1999. p 119.
    - collpase of multiple vertebra implies:
          - Gaucher's disease;
          - Mucopolysaccharidosis;
          - Osteogenesis imperfecta;
          - Lymphoma;
          - Metastatic disease;

- X-ray:
    - on lateral views, look for vertebral flattening (vertebra plana) which is a precursor to collapse;
    - note that non Hodgkin lymphoma of the spine may cause a compression fracture may give the
            appearance of vertebra plana;
    - always consider osteomyelitis of spine:

- Biopsy:
    - may be required for diagnosis unless the radiographic picture is
          classic or histiocytosis has already been diagnosed;

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- Non Operative Treatment:
    - lesion is usually self-limiting;
    - at least 50% reconstitution of vertebral height may be expected;
    - if there is no neurological deficit, lesion may be followed non operatively;
    - even w/ non-myelopathic neurological signs (numbness or weakness), bracing will often lead to resolution of symptoms;
    - bracing may also be used to prevent progressive kyphosis;
    - chemotherapy: is useful for the systemic form of disease;
    - low dose XRT:
            - may be indicated w/ neurologic deficits, esp if surgical decompression is not possible;
            - low-dose irradiation of the lesion (500 to 900 rads) is used;

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- Operative Treatment:
    - w/ severe neurologic deficit, surgical decompression & arthrodesis is indicated;

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Eosinophil granuloma of the spine.

Eosinophilic granuloma of the spine with and without vertebral plana: long term follow up of six cases.
      C Villas et al. J. Spinal Disorders.   vol 6(3). 1993. p 260-268.

Vertebral plana and eosinophilic granuloma of the cervical spine in children.
      H Sherk et al.   Spine Vol 3. p 116-121.   1978.    

Vertebral plana. Long term follow up in five patients.
      E. Ippolito et al.   JBJS. Vol 66(9)-A. 1984. p 1364-1368.

Ewing's sarcoma simulating vertebral plana.
      JO Poulsen et al.   Acta Orthop. Scand. vol 46(2) 1975. p 211-215.

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