Surgical treatment of pediatric thoracic or lumbar spinal Langerhans cell histiocytosis complicated with neurologic deficit

English Keywords:Langerhans cell histiocytosis  Children spine  Thoracolumbar spine  Neurologic deficit  Surgical outcomes

English Abstract:

  【Abstract】 Objectives: To review the surgical outcomes of pediatric thoracic or lumbar spinal Langerhans cell histiocytosis(LCH) complicated with neurologic deficit. Methods: Fourteen children suffering from thoracic or lumbar spinal LCH accompanied by neurologic deficit received surgical treatment from January 2005 to December 2012. There were 6 girls and 8 boys with an average age of 9.1 years old(range, from 2 to 16 years). All patients presented with local back pain and progressive neurologic deterioration. Frankel grade B was noted in 2 patients, grade C in 9 and grade D in 3. The lesion was noted at T3(2 cases), T4(1 case), T8(3 case), T11(2 cases), T12(1 case), L1(3 cases), L2(1 case) and L3(1 case). Posterior instrumentation combined with anterior corpectomy, decompression and allograft was performed in the early 7 patients(before 2006), while posterior pedicle screw fixation, laminectomy and repair of laminae with allograft was performed in 7 cases(after 2007). Results: Intraoperative histopathological examination was performed in all patients. The operation time was 330±122 minutes in combined approach group and 157±87 minutes in single approach group(P=0.000). The average blood loss was 933±370ml in combined procedure and 523±222ml in single posterior approach(P=0.041). Three of seven(42.9%) patients experiencing combined surgery were noted complications, which included left intercostal neuroglia(resolved after using NSAIDs for 2 weeks) in 1 case and left side pleural effusion(treated with drainage for 1 week) in 2 cases. However, no complications were noted in single approach group. The mean follow-up duration was 40.8 months(range, 24-64 months). No recurrence was noted in patients undergoing combined surgery. All patients had neurologic function recovered to Frankel E from 2 to 12 weeks after surgery. Conclusions: For pediatric spinal LCH, both combined and single posterior approaches can achieve good outcomes in relieving neurologic deficit. However, single posterior approach is more favorable with less complications and less risk of recurrence in residual vertebral body.