Eosinophilic granuloma of the cervical spine in adults: A review.

PURPOSE: Spinal eosinophilic granulomas(EGs) are uncommon tumors, constituting <1% of all bone tumors. They are mostly seen in the pediatric age group while adult onset is rare. Cervical spine is an infrequent location for involvement by EG. Available literature remains sparse regarding the clinical and management aspects of these lesions, especially in adults.

MATERIALS AND METHODS: Literature review was performed by searching online databases to analyze all the reported cases of adult onset cervical EG.

RESULTS: Sixty-two cases were identified and analysed. The male:female ratio was 3.1:1. The mean age at presentation was 32.8years(range18-71 years). Neck pain, limb weakness and restriction of movement were the most frequent symptoms. C2 vertebra was the most frequently involved. Vertebral body was involved in >80% cases and only two had vertebra plana morphology. The cervical lesions involved single vertebra in 42(82%) cases while 9(18%) cases had multiple vertebral involvement. Fifteen patients were managed conservatively, of whom seven failed requiring surgery later, 40 cases underwent definitive surgery and 17 received adjuvant treatment. Posterior-only surgeries were performed in 5, anterior-only in 20, and circumferential in 14 cases. The mean follow-up duration was 68 months (12-268months). Outcome was good to excellent in all, except one, irrespective of type of treatment received.

CONCLUSIONS: Cervical spine EG is rare in adults and usually presents as an osteolytic lesion involving the vertebral body and vertebra plana is very rare. Surgery is typically reserved for cases with severe neurological deficits and bony instability. Outcome appears good in majority of the cases.