Otsuki Bungo, Kimura Hiroaki, Fujibayashi Shunsuke, Shimizu Takayoshi, Sono Takashi, Murata Koichi, Matsuda Shuichi
Department of Orthopaedics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Orthopaedics, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan.
Spine Surg Relat Res. 2024 Jun 10;8(6):637-643. doi: 10.22603/ssrr.2024-0040. eCollection 2024 Nov 27.
Adult spinal Langerhans cell histiocytosis (LCH) presents a treatment challenge due to ongoing controversies. Traditional approaches such as curettage with bone grafting and internal fixation are preferred for severe cases involving mechanical instability, neurological deficits, or deformity. This study aimed to explore the efficacy of a customized approach involving simple posterior instrumentation without curettage or bone grafting in treating adult spinal LCH.
This retrospective study analyzed a prospectively maintained database of all spine surgeries conducted at our institute from April 2013 to December 2020. Adult patients (age≥20) diagnosed with LCH were included. We assessed surgical methods, adjuvant therapy, and clinical results, such as perioperative progression of disease, symptoms, and recurrence.
Four male patients aged between 21 and 28, each with a single spinal LCH lesion (T6, T5, and C5) except one case (T5 and T7), were treated. Diagnoses were confirmed via biopsy (two open, two needle biopsies). Whole-body computed tomography or bone scintigraphy revealed no additional LCH lesions in any patient, except in one patient with a small lung nodule. All patients presented with severe back or neck pain and pathological fractures at the affected vertebra. Thoracic LCH cases received percutaneous pedicle screw fixation, while the cervical case was managed with conventional posterior instrumentation using lateral mass screws. After surgery, all patients experienced significant pain relief, halted bone lysis, and rapid new bone formation. One patient underwent chemotherapy postsurgery. Over 3 years of follow-up, imaging studies revealed no recurrences of the disease.
Posterior instrumentation, without the need for curettage or bone grafting, is a promising surgical treatment for adult spinal LCH. This method may effectively halt lesion progression, prevent spinal deformity, and avert neurological deficits in the patients with progressive spine lesion where conservative treatment may not adequately prevent vertebral fractures.
成人脊柱朗格汉斯细胞组织细胞增多症（LCH）因存在诸多争议，在治疗上面临挑战。对于涉及机械性不稳定、神经功能缺损或畸形的严重病例，传统方法如刮除术加植骨和内固定是首选。本研究旨在探讨一种定制方法的疗效，该方法包括简单的后路内固定，无需刮除术或植骨，用于治疗成人脊柱LCH。
这项回顾性研究分析了我院2013年4月至2020年12月期间所有脊柱手术的前瞻性维护数据库。纳入诊断为LCH的成年患者（年龄≥20岁）。我们评估了手术方法、辅助治疗和临床结果，如疾病的围手术期进展、症状和复发情况。
治疗了4名年龄在21至28岁之间的男性患者，除1例有两个病变（T5和T7）外，其余患者均有单个脊柱LCH病变（T6、T5和C5）。通过活检（2例切开活检，2例针吸活检）确诊。除1例有小肺结节的患者外，全身计算机断层扫描或骨闪烁显像显示所有患者均无其他LCH病变。所有患者均出现严重的背部或颈部疼痛以及受累椎体的病理性骨折。胸椎LCH病例接受经皮椎弓根螺钉固定，而颈椎病例采用使用侧块螺钉的传统后路内固定治疗。术后，所有患者疼痛均显著缓解，骨溶解停止，新骨快速形成。1例患者术后接受了化疗。经过3年多的随访，影像学检查显示疾病无复发。
后路内固定，无需刮除术或植骨，是治疗成人脊柱LCH的一种有前景的手术方法。该方法可有效阻止病变进展，预防脊柱畸形，并避免在保守治疗可能无法充分预防椎体骨折的进行性脊柱病变患者中出现神经功能缺损。
