Primary Eosinophilic Granuloma of Adult Cervical Spine Presenting as a Radiculomyelopathy
A 29-year-old man had paresthesia on both arms and grasping weakness for 10 days. His cervical MRI showed diffuse marrow infiltration with pathologic fracture producing symmetrical collapse of the C7 vertebral body. In addition, epidural extension produced ventral cord compression without cord signal change (). On physical examination, he had mild weakness of grasping and elbow extension power on both arms (Grade IV). Laboratory tests were all within normal limits. 3D cervical CT scan revealed symmetrical collapse of C7 vertebral body and no involvement of posterior column (). Our first impression was tuberculous (Tb) spondylitis; as such, we did anti-Tb medication and Tb-related laboratory tests. However, his grasping power of both hands was worsened (Grade IV→III). Therefore, we performed C7 corpectomy and anterior plate fixation C6-T1 and iliac bone graft (). In the operative field, disc spaces above and below the level of lesion were not involved. After surgical management, motor weakness was improved (Grade III→IV) and paresthesia on both arms also got better. Pathological evaluation confirmed the diagnosis of eosinophilic granuloma. He was immobilized after surgery in a rigid cervical brace for 3 months. In the following outpatient clinic, positron emission tomography CT was conducted additionally, but no other lesions were found. Twelve months follow-up cervical MRI showed no recurrence () and his neurological deficits were fully recovered.