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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2000 April;51(2):69-72
Eosinophilic granuloma. Three cases of cervical spine localisation in pediatric age
Capilupi B., Bonaspetti G., Novati G., Borroni C., Pazzaglia U. E.
Eosinophilic granuloma of the bone is classified in the histiocytosis X. Sixty per cent of the patients affected by eosinophilic granuloma are younger than twenty whereas the thirty-five per cent are younger than ten. The severity of the pathology is inversely proportional to age: the youngest the patient the most severe the lesion. In spine localisation osteolysis is the most frequent image, in thoracic spine the most frequent image is vertebral collapse. Eosinophilic granuloma is the first cause of vertebra plana. Usually only one vertebra is affected; rarely there is medullar compression. Pain is a constant symptom which often occurs as a non traumatic stiff neck. Three pediatric female patients were treated for cervical spine eosinophilic granuloma. In two cases there was isolated cervical spine localisation. The first symptom was a stiff neck and both recovered in six months. The third case showed a multiple localisation involving the odontoid process of C2, without neurological complications. The treatment was conservative also in the third case and the child recovered. As agreed with Raab, the bone lesion curettage and bone graft are not to be considered the first approach. It is suggested that if neurological lesions or serious spine instability are not present, the radiological and clinical observation, with the patient wearing a cast, is the best solution.