Nakamura Naoyuki, Inaba Yutaka, Aota Yoichi, Machida Jiro, Saito Tomoyuki
Department of Pediatric Orthopedic Surgery, Kanagawa Children's Medical Center.
Department of Orthopedic Surgery, Yokohama City University.
J Pediatr Orthop. 2019 Apr;39(4):e308-e311. doi: 10.1097/BPO.0000000000001283.
Pediatric Langerhans cell histiocytosis (LCH) often results in vertebral compression fracture. However, few reports have reported vertebral remodeling during the course of LCH. We aimed to investigate the longitudinal reconstitution and transformation of the affected vertebrae and the adjacent structures in young children with spinal LCH.
We recruited 13 patients, including 16 affected vertebrae, diagnosed with LCH via biopsy. The average age at first visit was 3.6 years. The average follow-up period was 10.2 years. Vertebral lesions involved L2 in 3 cases; T12, L1, or L5 in 2 cases; and C4, C5, C7, T5, T8, T9, or L3 in 1 case. We measured the ratios of the height of the affected vertebra and 1 vertebra above the affected one to that of the second vertebra above the affected one, local kyphotic angles, and the ratio of the height of the center of the adjacent disk to that of one disk above it.
The collapse of the affected vertebra was most severe after 1 year of disease onset. The rate of reconstitution accelerated at 2 years or later of disease onset. The recovery speed of the anterior wall was faster than that of the center height. While the height of the affected vertebrae was restored, the thickness of the adjacent disk also increased. Further, the height of the adjacent vertebrae increased in a similar manner. The average local kyphosis angle shifted to lordosis within the first 3 years.
The heights of not only the disk but also the adjacent vertebra increased during the vertebral collapse phase in pediatric spinal LCH patients. These transformations may affect the realignment of the sagittal spinal balance at the earlier stage of the disease. During the collapse phase, the heights of the adjacent vertebrae and disks increase but after the affected vertebrae reconstituted, the augmentation of adjacent vertebrae and disks diminished.
Level IV.
儿童朗格汉斯细胞组织细胞增生症（LCH）常导致椎体压缩性骨折。然而，关于LCH病程中椎体重塑的报道较少。我们旨在研究小儿脊柱LCH患者受累椎体及相邻结构的纵向重建和转变情况。
我们招募了13例经活检确诊为LCH的患者，包括16个受累椎体。首次就诊时的平均年龄为3.6岁。平均随访期为10.2年。椎体病变累及L2者3例；累及T12、L1或L5者2例；累及C4、C5、C7、T5、T8、T9或L3者1例。我们测量了受累椎体及其上方1个椎体的高度与受累椎体上方第2个椎体高度的比值、局部后凸角以及相邻椎间盘中心高度与上方1个椎间盘高度的比值。
发病1年后受累椎体塌陷最为严重。发病2年及以后重建速度加快。前壁的恢复速度快于中心高度的恢复速度。在受累椎体高度恢复的同时，相邻椎间盘的厚度也增加。此外，相邻椎体的高度以类似方式增加。平均局部后凸角在最初3年内转为前凸。
小儿脊柱LCH患者在椎体塌陷阶段，不仅椎间盘高度增加，相邻椎体高度也增加。这些转变可能在疾病早期影响脊柱矢状面平衡的重新排列。在塌陷阶段，相邻椎体和椎间盘高度增加，但受累椎体重建后，相邻椎体和椎间盘的增大减弱。
四级。
