Eosinophilic Granuloma of the Cervical Spine in Adults: A Review

Objective: Spinal eosinophilic granulomas (EGs) are uncommon tumors, constituting <1% of all bone tumors. They are mostly seen in the pediatric age group, whereas adult onset is rare. The cervical spine is an infrequent location for EG. The literature is sparse regarding the clinical and management aspects of these lesions, especially in adults. Methods: A 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 analyzed. The male/female ratio was 3.1:1. The mean age at presentation was 32.8 years (range, 18–71 years). Neck pain, limb weakness, and restriction of movement were the most frequent symptoms. The C2 vertebra was the most frequently involved. The vertebral body was involved in >80% of patients and only 2 had vertebra plana morphology. The cervical lesions involved single vertebra in 42 patients (82%), whereas 9 patients (18%) had multiple vertebral involvement. Fifteen patients were managed conservatively, of whom 7 failed and required surgery later; 40 patients underwent definitive surgery and 17 received adjuvant treatment. Posterior-only surgeries were performed in 5 patients, anterior-only in 20, and circumferential in 14. The mean follow-up duration was 68 months (range, 12–268 months). The outcome was good to excellent in all, except 1, 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; vertebra plana is very rare. Surgery is typically reserved for patients with severe neurologic deficits and bony instability. The outcome seems good in most cases.