A Specific Osteolytic Destruction of Lumbar Spine in a Young Girl

Case Report

Austin J Clin Case Rep. 2014;1(9): 1045.

A Specific Osteolytic Destruction of Lumbar Spine in a Young Girl

Baogan Peng* and Duanming Li

Department of Spinal Surgery, General Hospital of Armed Police Force, China

*Corresponding author: Baogan Peng, Department of Spinal Surgery, Institute of Spinal Surgery of Armed Police Force, General Hospital of Armed Police Force, 69 Yongding Road, Beijing 100039, P.R. China

Received: August 06, 2014; Accepted: September 04, 2014; Published: September 06, 2014

Abstract

This report described a young child with osteolytic destruction in two adjacent vertebral bodies along with the intervertebral disc, and reveals its possible mechanism. CT scan with 2-demensional reconstruction showed the osteolytic destruction in the upper third portion of L3 vertebral body and the lower endplate erosion of L2 vertebral body. The lesion has also involved L2/3 disc. A comprehensive preoperative evaluation did not identify a specific cause of vertebral destruction. In order to confirm the diagnosis and completely excise the lesion, we implemented a posterior lumbar interbody fusion. Low back pain disappeared immediately following the operation. Histopathological study showed a great deal of B-lymphocytes and macrophages infiltration. Studies of its pathogenesis reveal that it is likely to be a B-lymphocyte mediated local immune inflammatory reaction in the lumbar spine.

Keywords: Osteolytic destruction; Lumbar spine; B-lymphocyte; Macrophage; Inflammation; Immune reaction

Osteolytic destruction of vertebral body is commonly related to the pathologic process of spine tumors, or tumor-like lesions, infection, and avascular necrosis [1-3]. At present, we report a case of young girl with the osteolytic destruction in L2 and L3 two adjacent vertebral bodies along with L2/3 intervertebral disc. We ruled out the possibility of malignancy, infection, and avascular necrosis. To the best of our knowledge, no lesion of this type has been reported in a young child previously.

Case Presentation

A 3 years old girl had a history of low back pain for 6 months. She was delivered through a caesarean section at full term with normal intelligence. Pain consistently aggravated her as she stood and walked for a long time, and did not fade after various conservative therapies including lumbar immobilization using bracing, physical therapy and oral painkiller. The patient had no history of major illness and trauma in the past. There was no history of long term febrile or night sweat during the course of illness. Physical examination revealed a stiff lumbar spine. There were tenderness and percussion pain over the L2-L4 lumbar spine. After admission, all imaging examinations including lumbar plain radiography, CT, MRI, whole-body bone scan, and chest clairvoyance were carried out together with laboratory examinations. No abnormality was detected by chest clairvoyance or abdominal ultrasonic examination. Laboratory results were either negative or within normal range. The plain radiographs of lumbar spine showed irregular changes in the upper endplate of L3 vertebral body and narrowing in the L2/3 intervertebral space. CT scan with 2-demensional reconstruction showed the osteolytic destruction in the upper 1/3 portion of L3 vertebral body and the lower endplate erosion of L2 vertebral body. The lesion had involved the L2/3 disc (Figure 1). T2-weighted MR images displayed irregular high signal intensity in the L3 vertebral body and the lower 1/2 portion of L2 vertebral body. Whole-body isotope bone scan demonstrated a high uptake in the L2 and L3 vertebral bodies, especially in the L3 vertebral body (Figure 2).