title: Eosinophilic granuloma of spine in adults: a report of 30 cases and outcome.
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.
authors.affiliation: The Spine Center, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
authors.forename: Wending
authors.initials: W
authors.lastname: Huang
authors.forename: Xinghai
authors.initials: X
authors.lastname: Yang
authors.forename: Dong
authors.initials: D
authors.lastname: Cao
authors.forename: Jianru
authors.initials: J
authors.lastname: Xiao
authors.forename: Mosong
authors.initials: M
authors.lastname: Yang
authors.forename: Dapeng
authors.initials: D
authors.lastname: Feng
authors.forename: Quan
authors.initials: Q
authors.lastname: Huang
authors.forename: Zhipeng
authors.initials: Z
authors.lastname: Wu
authors.forename: Wei
authors.initials: W
authors.lastname: Zheng
authors.forename: Lianshun
authors.initials: L
authors.lastname: Jia
authors.forename: Shujia
authors.initials: S
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D003131:Combined Modality Therapy / Q000379:methods*; D018450:Disease Progression; D004358:Drug Therapy / Q000379:methods; D004803:Eosinophilic Granuloma / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000379:methods; D011878:Radiotherapy / Q000379:methods; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult