Histiocitosis of the Pediatric Spine. Clinical and Radiographic Analysis of Seventy-One Vertebral Lesions

Objective: To report clinical and radiographic findings, to evaluate the results of modern treatment, complications and long term follow up.

Method: Forty-one patients with spinal histiocytosis with biopsy proven were studied. A follow up of 7.5 years (2.7 to 15.7 years).The age at the diagnosis was 5.7 years (0.6 to 12.5 years). The vertebral body was the most commonly affected 69%, posterior arch 8.5% and both 22.5%. Eighteen patients had osseous lesions. Vertebral body collapse was measured by Washington University and Children´s Hospital of Philadelphia classification.

Results: The most common symptom was pain (87 %). Twenty eight patients had spinal deformity associated with lesions site, 22 kyphosis with mean angular value 17 (12 to 38 ), 2 patients lordosis and 4 patients scoliosis with mean angular value 12 (10 to 22 ). None of the forty one patients (100%) had evidence of persistent or active disease through 5.5 years follow up. From seventy one involved vertebrae, 34 had symmetric collapse (A), 31 symmetric collapse (B); The radigraphic classification was 35% collapse type II B, 24% type I A, 24% type II A, 8% type I B and 8 % type III. 31 patients had medical treatment: 9 patients combination of chemotherapy and corticoids; 6 patients; 3 patients chemotherapy; 8 patients radiation therapy; 2 patients radiation plus corticoids, 2 patients chemotherapy, radiation and corticoids and 1 patients chemotherapy plus radiotherapy. Only three patients had indication for surgery due to neurologic symptoms and seven patients just followed by radiographic and observation. Fifteen patients wore cast and brace.

Conclusions: We had high incidente of cervical lesions associated with neurologic cervical symptoms 71%. The symmetric collapsed were the most common presentation. All the spinal deformity had good resolution and none had progressions. The surgery is usually not indicated.