Tumors and infections of the growing spine.

IF 1.3 4区 医学 Q3 ORTHOPEDICS Journal of Childrens Orthopaedics Pub Date : 2023-11-24 eCollection Date: 2023-12-01 DOI:10.1177/18632521231215857
Barbara Jasiewicz, Ilkka Helenius
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Abstract

The growing spine differs from the adult spine in several ways. Although tumors and infections cause only a small percentage of pediatric back pain incidences, delayed proper diagnosis and treatment may be disastrous. Benign lesions, such as osteoid osteoma, osteoblastoma, and aneurysmal bone cyst in the spine, are predominant during the first two decades of life, whereas malignant bony spinal tumors are rare. In the pediatric population, malignant spine tumors include osteosarcoma, Ewing's sarcoma, lymphoma, and metastatic neuroblastoma. Infections of the growing spine are rare, with the incidence of discitis peaking in patients under the age of 5 years and that of vertebral osteomyelitis peaking in older children. Spondylodiscitis is often a benign, self-limiting condition with low potential for bone destruction. Conservative treatments, including bedrest, immobilization, and antibiotics, are usually sufficient. Spinal tuberculosis is a frequently observed form of skeletal tuberculosis, especially in developing countries. Indications for surgical treatment include neurologic deficit, spinal instability, progressive kyphosis, late-onset paraplegia, and advanced disease unresponsive to nonoperative treatment. Spinal tumors and infections should be considered potential diagnoses in cases with spinal pain unrelated to the child's activity, accompanied by fever, malaise, and weight loss. In spinal tumors, early diagnosis, fast and adequate multidisciplinary management, appropriate en bloc resection, and reconstruction improve local control, survival, and quality of life. Pyogenic, hematogenous spondylodiscitis is the most common spinal infection; however, tuberculosis-induced spondylodiscitis should also be considered. Level of evidence: level 4.

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生长中的脊柱的肿瘤和感染。
生长中的脊柱在几个方面与成人脊柱不同。虽然肿瘤和感染只占儿童背痛发病率的一小部分,但延迟适当的诊断和治疗可能是灾难性的。脊柱的良性病变,如骨样骨瘤、成骨细胞瘤和动脉瘤样骨囊肿,在生命的前20年是主要的,而恶性脊柱骨肿瘤是罕见的。在儿科人群中,恶性脊柱肿瘤包括骨肉瘤、尤文氏肉瘤、淋巴瘤和转移性神经母细胞瘤。生长中的脊柱感染是罕见的,椎间盘炎的发病率在5岁以下的患者中达到高峰,而椎体骨髓炎的发病率在较大的儿童中达到高峰。脊椎椎间盘炎通常是一种良性的、自限性的疾病,对骨的破坏可能性很小。保守治疗,包括卧床、固定和抗生素,通常就足够了。脊柱结核是骨骼结核的一种常见形式,特别是在发展中国家。手术治疗的适应症包括神经功能缺损、脊柱不稳定、进行性后凸、迟发性截瘫和对非手术治疗无反应的晚期疾病。脊柱肿瘤和感染应被认为是与儿童活动无关的脊柱疼痛的潜在诊断,并伴有发烧、不适和体重减轻。在脊柱肿瘤中,早期诊断、快速和充分的多学科治疗、适当的整体切除和重建可提高局部控制、生存率和生活质量。化脓性、血液性脊柱炎是最常见的脊柱感染;然而,结核性脊柱炎也应考虑在内。证据等级:四级。
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来源期刊
Journal of Childrens Orthopaedics
Journal of Childrens Orthopaedics Medicine-Orthopedics and Sports Medicine
CiteScore
2.70
自引率
14.30%
发文量
61
审稿时长
23 weeks
期刊介绍: Aims & Scope The Journal of Children’s Orthopaedics is the official journal of the European Paediatric Orthopaedic Society (EPOS) and is published by The British Editorial Society of Bone & Joint Surgery. It provides a forum for the advancement of the knowledge and education in paediatric orthopaedics and traumatology across geographical borders. It advocates an increased worldwide involvement in preventing and treating musculoskeletal diseases in children and adolescents. The journal publishes high quality, peer-reviewed articles that focus on clinical practice, diagnosis and treatment of disorders unique to paediatric orthopaedics, as well as on basic and applied research. It aims to help physicians stay abreast of the latest and ever-changing developments in the field of paediatric orthopaedics and traumatology. The journal welcomes original contributions submitted exclusively for review to the journal. This continuously published online journal is fully open access and will publish one print issue each year to coincide with the EPOS Annual Congress, featuring the meeting’s abstracts.
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