The surgical strategy for eosinophilic granuloma of the pediatric cervical spine complicated with neurologic deficit and/or spinal instability

Abstract

BackgroundVarious therapeutic approaches have been proposed for the treatment of pediatric patients with eosinophilic granuloma (EG) of the cervical spine. Our aim was to discuss and present our experience with the individualized surgical intervention of pediatric cervical EG complicated with neurologic deficits and/or spinal instability.MethodsWe retrospectively analyzed the clinical data of 19 children who were diagnosed with cervical EG comor spinal/or spinal instability (evaluated by the Spinal Instability Neoplastic Score, SINS ≥ 7) and treated surgically in our institution.ResultsLesions involved C1–2 in 7 patients and C3–7 in 12 patients. Anterior tumor resection combined with posterior pedicle screw fixation, anterior approach of excision and instrumentation, and posterior tumor resection combined with pedicle screws instrumentation were selected according to the different locations of tumors. Frankel scale and Oucher scale improved significantly after surgery. There was no morphologic alteration of the neck at follow-up.ConclusionsSurgery can significantly improve the neurologic status and symptoms. Surgical decision-making must be individually tailored to minimize the influence of surgery on spine growth.

Paradigm shift in vertebral eosinophilic granuloma

“…In adults, unlike children, the disease may progress more aggressively as the growth of the epiphysis stops [11]. Therefore, some authors advocated the application of more aggressive treatment methods in adults [12,13,14]. In the study of Wending et al involving 30 patients, surgical treatment was applied to 28 patients [12].…”

“…In the study of Wending et al involving 30 patients, surgical treatment was applied to 28 patients [12]. In the study of Zhong et al, which included 19 patients, surgical treatment was applied to all patients [13]. In another study, Floman et al 7 of 20 patients underwent surgical treatment [14].…”

Posterior pedicle screw fixation combined with local steroid injections for treating axial eosinophilic granulomas and atlantoaxial dislocation: A case report

“…The prognosis is poorer when more vertebral bodies are implicated and the patient is younger. Early-stage patients with no visible neurological symptoms or spinal instability may benefit from conservative treatments such bed rest, bracing, traction, and medication[ 2 , 17 ]. Bed rest and brace immobilization have obvious effects on patients with mild vertebral lesions, can restore the height of the collapsed vertebral body and relieve pain and mild neurological symptoms, and thus can be used as the initial treatment of spinal EG[ 1 , 18 ].…”

“…The surgical strategy is determined by the focus's location and the extent of surrounding involvement. Curettage and biopsy, subtotal corpectomy, corpectomy with fusion, laminectomy, or posterior fusion are among the surgical options[ 1 , 2 , 6 , 17 , 20 ].…”