Eosinophilic granuloma of the pediatric cervical spine.
METHODS
Retrospective case review of children with eosinophilic granuloma of the cervical spine.


OBJECTIVE
To present the clinical features, radiographic findings, management, and results of 7 pediatric patients with eosinophilic granuloma of the cervical spine.


BACKGROUND
Management of the eosinophilic granuloma of the pediatric cervical spine is challenging, and must be adapted according to the patient, as no level I evidences have been produced. The therapeutic goals in these children are spinal stability, preservation of neurologic function, and relief of pain, always keeping in mind that patients are still growing. The localization in the cervical spine of children is extremely rare, with less than 50 patients reported in literature between 1966 and 2008.


METHODS
We reviewed the 7 pediatric patients with a diagnosis of eosinophilic granuloma of the cervical spine who were managed between 1970 and 1990 by the senior author. All patients presented with isolated cervical spine involvement, and all of them had a histologic diagnosis of eosinophilic granuloma (EG). All had open physes.


RESULTS
There were 5 boys and 2 girls (mean age: 10 years; range 4-16). We followed-up patients for 19 years (range 8-29). The symptoms at presentation varied according to the localization of the tumor in the cervical spine.


CONCLUSIONS
Management of pediatric patients with EG of the cervical spine is challenging, especially when there is neurologic involvement. Observation alone, prolonged immobilization, systemic chemotherapy, curettage with or without bone grafting, corticosteroid injection, and low dose radiation therapy have been proposed for the management of patients with EG. Surgery is required when the child presents neurologic involvement. Children who received a vertebral interbody fusion can show, at long period follow-up, normal shape of the neck, with maintenance of the normal motion of the adjacent segments.
Denaro
Luca
L
Department of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
Longo
Umile Giuseppe
UG
Papalia
Rocco
R
Di Martino
Alberto
A
Maffulli
Nicola
N
Denaro
Vincenzo
V
D000293:Adolescent; D001416:Back Pain / Q000209:etiology / Q000473:pathology; D001706:Biopsy; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004803:Eosinophilic Granuloma / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000473:pathology; D008297:Male; D019637:Orthopedic Procedures; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D013997:Time Factors; D014103:Torticollis / Q000209:etiology / Q000473:pathology; D016896:Treatment Outcome