1. A case of vertebra plana (Calvé) is described and serial radiographs throughout the course of the disease are presented. 2. The initial radiographs showed a vertebra of normal depth which collapsed to a thin disc in fifteen days. Since the symptoms had begun twelve days before the first examination the total time taken to reach this stage was twenty-seven days. 3. The literature has been reviewed for evidence of the underlying pathology of vertebra plana. In the case described biopsy of the affected vertebral body was not carried out, and thus the nature of the underlying change could not be determined

Aims. The aim of this study was to report the long-term prognosis of patients with multiple Langerhans cell histiocytosis (LCH) involving the spine, and to analyze the risk factors for progression-free survival (PFS). Methods. We included 28 patients with multiple LCH involving the spine treated between January 2009 and August 2021. Kaplan-Meier methods were applied to estimate overall survival (OS) and PFS. Univariate Cox regression analysis was used to identify variables associated with PFS. Results. Patients with multiple LCH involving the spine accounted for 15.4% (28/182 cases) of all cases of spinal LCH: their lesions primarily involved the thoracic and lumbar spines. The most common symptom was pain, followed by neurological dysfunction. All patients presented with osteolytic bone destruction, and 23 cases were accompanied by a paravertebral soft-tissue mass. The incidence of vertebra plana was low, whereas the oversleeve-like sign was a more common finding. The alkaline phosphatase was significantly higher in patients with single-system multifocal bone LCH than in patients with multisystem LCH. At final follow-up, one patient had been lost to follow-up, two patients had died, three patients had local recurrence, six patients had distant involvement, and 17 patients were alive with disease. The median PFS and OS were 50.5 months (interquartile range (IQR) 23.5 to 63.1) and 60.5 months (IQR 38.0 to 73.3), respectively. Stage (hazard ratio (HR) 4.324; p < 0.001) and chemotherapy (HR 0.203; p < 0.001) were prognostic factors for PFS. Conclusion. Pain is primarily due to segmental instability of the spine from its destruction by LCH. Chemotherapy can significantly improve PFS, and radiotherapy has achieved good results in local control. The LCH lesions in some patients will continue to progress. It may initially appear as an isolated or single-system LCH, but will gradually involve multiple sites or systems. Therefore, long-term follow-up and timely intervention are important for patients with spinal LCH. Cite this article: Bone Joint J 2023;105-B(6):679–687

Abstract

Purpose: A complete collapse of osteoporotic vertebral fractures is difficult to treat. Restoration of vertebral height is very difficult, if ever possible. Kyphoplasty has been shown to restore vertebral compression fractures; however the best results are achieved in fractures without total collapse. Nevertheless some fractures develop osteonecrosis and pseudarthosis which can be easily seen on X-ray. For those cases we performed a retrospective study in order to evaluate the capacity of kyphoplasty in those difficult situations. Methods: We analyzed the pre- and postoperative X-rays of vertebra plana treated between 2002 and 2005. Vertebral height (vh -anterior, middle and posterior) and kyphotic angle were measured with a digital imaging system. 2 independent examiners classified the preoperative X-rays into fractures with osteonecrosis/pseud-arthrosis (group 1) and without osteonecrosis (group 2). Statistical analysis with the non-parametric Mann-Whitney test was performed. Results: Between 2002 and 2005 we performed 315 kyphoplasties. A total collapse of the vertebra (vertebra plana) was treated in 15 cases. Mean age 76 years, SD 5.2 years, average time of treatment after fracture 4 months. Osteonecrosis was persistent in 8 cases. The osteonecrosis group found a statistically significant higher degree of vertebral reconstruction (p < 0.013 - group 1: anterior vh 33%, middle vh 37,8%, posterior vh 19,1%; group 2: anterior vh 4,9%, middle vh 17,5%, posterior vh 1,8%). No significant difference was found in the analysis of the pre- and postop. kyphotic angle which could be due to the small sample size as the mean values are three-fold elevated in group 1 (p = 0.146, group 1: restoration mean 9,1° - maximum 18°; group 2: restoration mean 3,5° - maximum 13°). Conclusions: Osteonecrosis is a positive predictive sign for the potential of vertebral reconstruction. Vertebral height can be significantly improved in those patients and the major changes of the kyphotic angle are possible. Even after 4 months, correction of the deformity is possible with kyphoplasty. However, without this sign, restoration of the vertebral height and correction of kyphosis is limited to rare cases

Back pain is a common symptom in children and adolescents. Here we review the important causes, of which defects and stress reactions of the pars interarticularis are the most common identifiable problems. More serious pathology, including malignancy and infection, needs to be excluded when there is associated systemic illness. Clinical evaluation and management may be difficult and always requires a thorough history and physical examination. Diagnostic imaging is obtained when symptoms are persistent or severe. Imaging is used to reassure the patient, relatives and carers, and to guide management.

Cite this article: Bone Joint J 2014;96-B:717–23.