Langerhans' cell histiocytosis of the spine - Analysis of twenty-three cases

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 dale. 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.