Percutaneous vertebroplasty for Langerhans cell histiocytosis of the lumbar spine in an adult: Case report and review of the literature

Abstract

Langerhans cell histiocytosis (LCH) is extremely rare in the lumbar spine of adults. The radiological features typically manifest as vertebral tumors. The exact etiology of LCH remains unknown. Langerhans cells may cause local or systemic effects. The most frequent sites of these bony lesions are the skull, femur, mandible, pelvis and spine. To date, only 3 spinal LCH cases treated by percutaneous vertebroplasty (PVP) have been reported. The present study reports a case of LCH of the fourth lumbar vertebra (L4) in a 51-year-old male with a 10-day history of low back pain, limited waist motion and right lower limb numbness. The patient was treated using PVP. The use of PVP for treating LCH of the spine was successful. The present study provides an up-to-date literature overview of LCH.

Langerhans cell histiocytosis at L5 vertebra treated with en bloc vertebral resection: a case report

“…Reportedly, only 4.1% of LCH osseous lesions occur in the lumbar spine [ 3 ], and involvement of spinal canal, nerve root or, paravertebral tissue is extremely rare [ 6 ]. In literature, no more than 10 cases of lumbar LCH were reported [ 5 , 7 – 12 ], and four of them were treated with partial or complete surgical excision [ 8 , 9 , 11 , 12 ]. In the present case, the intolerable neurological pain, indefinite diagnosis, and suspicious vertebral metastasis reported in biopsy led to a radical surgery to remove the lesion.…”

“…While there is no consensus on the management of LCH, a number of approaches, including surgery, chemotherapy, radiotherapy, glucocorticoid, monoclonal antibody, and even nonsteroidal anti-inflammatory drugs (NSAIDS), were used to treat LCH [ 5 , 11 , 18 , 19 ]. For skeletal LCH, surgery should be considered if there is neurological involvement or histological diagnosis was not confident in biopsy [ 20 – 22 ].…”

“…Currently, the optimal treatments for spinal LCH remain controversial. While most cases of spinal LCH were treated conservatively, surgical curettage or excision was also reported [ 6 , 9 , 11 ]. Occasionally, solidary lumbar LCH was treated with hemi-vertebral resection through a posterolateral approach [ 9 ].…”

Spinal Langerhans cell histiocytosis with cord compression and neurological deficits: A case report

“…Fewer cases of LCH in adults were reported to affect the lumbar spine. For instance, Feng et al [ 13 ] in 2012, described a 51-year-old man who presented with low back pain, weakness of the trunk muscles, and lower extremity numbness. His spinal imaging revealed a single osteolytic lesion at the fourth lumbar vertebra with cord compression [ 13 ].…”

Cervical langerhans cell histiocytosis mimicking cervical tuberculosis

“…[8] Patients usually have local neck pain, limited range of motion, or neurological dysfunction. [9,10]…”