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学科主题: 临床医学
题名:
Langerhans Cell Histiocytosis of the Cervical Spine A Single Chinese Institution Experience With Thirty Cases
作者: Jiang, Liang1; Liu, Zhong Jun1; Liu, Xiao Guang1; Zhong, Wo Quan1; Ma, Qing Jun1; Wei, Feng1; Dang, Geng Ting1; Yuan, Hui Shu2
关键词: Langerhans cell histiocytosis ; cervical spine ; biopsy ; treatment
刊名: SPINE
发表日期: 2010
DOI: 10.1097/BRS.0b013e3181b8aa2d
卷: 35, 期:1, 页:E8-E15
收录类别: SCI
文章类型: Article
WOS标题词: Science & Technology
类目[WOS]: Clinical Neurology ; Orthopedics
研究领域[WOS]: Neurosciences & Neurology ; Orthopedics
关键词[WOS]: TERM-FOLLOW-UP ; EOSINOPHILIC GRANULOMA ; PEDIATRIC SPINE ; VERTEBRA PLANA ; CHILDREN ; BONE ; SCINTIGRAPHY
英文摘要:

Study Design. A retrospective study of cervical Langerhans cell histiocytosis (LCH).

Objective. To evaluate the safety and efficiency of the present diagnosis and treatment strategy.

Summary of Background Data. The diagnosis and treatment protocols are still controversial for the rarity of cervical LCH.

Methods. Thirty patients with cervical LCH were diagnosed in the past 10 years. Biopsy was routinely performed to establish the final diagnosis before treatment. Immobilization was usually the first choice. Low-dose radiotherapy was suggested for cases with solitary marked bony erosion and/or soft tissue extension, and chemotherapy for cases with multiple lesions. Surgery was preserved for suspected malignancy, neurologic deficits, severe deformity, and/or instability.

Results. The mean age at diagnosis was 14.2 (range: 1.5-41) years old. Neck pain (96.7%) was the most common symptom, followed by restricted motion (70%), neurologic symptoms (36.7%), and torticollis (30%). Four cases had multiple lesions. Fourteen cases had atlantoaxial lesion and 16 cases were subaxial. The lesion extended to paravertebral soft tissue in 40% cases, to epidural space in 30%, to pedicle and/or transverse process in 56.3%. One case had endplate destruction. The accuracy of percutaneous needle biopsy under CT guidance was 91.2%. Eighteen patients had conservative treatment and 12 underwent operation. Three cases involving C2 vertebral body had fixed atlantoaxial anterior dislocation. Another 3 cases with atlantoaxial lateral mass destruction had spontaneous fusion. Eighteen patients had conservative treatment (1 only by immobilization, 13 by radiotherapy, 2 by chemotherapy, and 2 by combined chemotherapy and radiotherapy) and 12 underwent operation. All the initial symptoms were resolved, and there was no recurrence. From retrospective view, the surgical procedure might be avoided in 60% cases. Twenty-five cases had an average 61.6-month follow-up. In cases with severe bony collapse, the vertebral height ratio increased from 20.0% to 44.9% and the lateral mass height ratio from 22.2% to 56.8%.

Conclusion. Cervical LCH lesions often extend to paravertebral soft tissue, epidural space, pedicles, and even to the endplate and lamina. Needle biopsy under CT guidance is safe and effective. The prognosis of cervical LCH is generally fair. Conservative treatment is usually enough and surgery should be reserved for major neurologic defects like myelopathy or monoparesis.

语种: 英语
WOS记录号: WOS:000274245200027
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/55707
Appears in Collections:北京大学第三临床医学院_骨科_期刊论文

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作者单位: 1.Peking Univ, Hosp 3, Dept Orthopaed, Beijing 100191, Peoples R China
2.Peking Univ, Hosp 3, Dept Radiol, Beijing 100191, Peoples R China

Recommended Citation:
Jiang, Liang,Liu, Zhong Jun,Liu, Xiao Guang,et al. Langerhans Cell Histiocytosis of the Cervical Spine A Single Chinese Institution Experience With Thirty Cases[J]. SPINE,2010,35(1):E8-E15.
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