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Vertebral Changes in Childhood Leukemia

Vertebral Changes in Childhood Leukemia Vertebral Changes in Childhood Leukemia 1 Bernard S. Epstein , M.D. Long Island Jewish Hospital, New Hyde Park, L. I., N. Y. Excerpt The osseous changes produced by leukemia in children have long been recognized, the acute lymphatic form being the chief offender. Best known are the radiolucent transverse bands at the diaphyseal ends of the long bones, ascribed primarily to pressure effects of proliferating packed leukemic cells on actively growing bone. Other structural changes include focal destruction of cancellous and cortical bone, perforations of bone cortex, periosteal elevation, subperiosteal bone formation, diffuse osteoporosis, and occasionally osteosclerosis (1, 8). Extensive leukemic deposits may be present in the bone marrow with no visible effect. While in some cases osseous involvement may produce no discomfort, in others there may be pain which is readily confused with rheumatic symptoms. Spinal involvement in leukemia has not received as much attention as the better recognized changes in the extremities. Vertebral osteoporosis, compressional deformities, and occasional instances of bone destruction have been recorded (3). The present report describes the radiologic changes in the spines of 15 children with leukemia, varying in age from six months to fourteen years, including 5 mentioned previously (5). Of these children, 1 was six months old and another was seventeen months; 6 were between two and six years of age, and 7 were between seven and fourteen years. The group was about evenly divided between males and females. The known duration of the disease ranged from about ten weeks to well over two years. Acute lymphatic leukemia was diagnosed in 9 cases. In 1 the diagnosis was acute myeloblastic leukemia, while in the others no specific cell type was established. In all instances, characteristic roentgenographic changes were noted in the extremities. Necropsy observations were made in 7 cases. The radiographic changes noted in the vertebrae included diffuse demineralization of the bodies, the neural arches, and the transverse processes. The loss of bone density appeared to be more pronounced in the thoracic and the upper lumbar spine. In 6 of the children, this demineralization was greater in the centers of the vertebrae than at their peripheries. Varying degrees of compression of the vertebral bodies were observed, the most common structural change being anterior wedging. In some infants the anterior venous sinuses in the middle and lower thoracic vertebrae were widened. Thinning and breaking of the cortical margins were occasionally seen, but these features were better demonstrated on postmortem roentgenograms of vertebral slabs. Of particular interest were horizontal zones of radiolucency at the upper and lower aspects of the vertebral bodies, corresponding to similar zones at the ends of the long bones. This is considered to be analogous to the disturbances of endochondral growth in the extremities, inasmuch as the vertebral epiphyses are at the cephalic and caudal aspects (2). http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Radiology Radiological Society of North America, Inc.

Vertebral Changes in Childhood Leukemia

Epstein, Bernard S.
Radiology , Volume 68 (1): 65 – Jan 1, 1957
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Publisher
Radiological Society of North America, Inc.
Copyright
Copyright © 1957 by Radiological Society of North America
ISSN
1527-1315
eISSN
0033-8419
DOI
10.1148/68.1.65
pmid
13401016
Publisher site
See Article on Publisher Site

Abstract

Vertebral Changes in Childhood Leukemia 1 Bernard S. Epstein , M.D. Long Island Jewish Hospital, New Hyde Park, L. I., N. Y. Excerpt The osseous changes produced by leukemia in children have long been recognized, the acute lymphatic form being the chief offender. Best known are the radiolucent transverse bands at the diaphyseal ends of the long bones, ascribed primarily to pressure effects of proliferating packed leukemic cells on actively growing bone. Other structural changes include focal destruction of cancellous and cortical bone, perforations of bone cortex, periosteal elevation, subperiosteal bone formation, diffuse osteoporosis, and occasionally osteosclerosis (1, 8). Extensive leukemic deposits may be present in the bone marrow with no visible effect. While in some cases osseous involvement may produce no discomfort, in others there may be pain which is readily confused with rheumatic symptoms. Spinal involvement in leukemia has not received as much attention as the better recognized changes in the extremities. Vertebral osteoporosis, compressional deformities, and occasional instances of bone destruction have been recorded (3). The present report describes the radiologic changes in the spines of 15 children with leukemia, varying in age from six months to fourteen years, including 5 mentioned previously (5). Of these children, 1 was six months old and another was seventeen months; 6 were between two and six years of age, and 7 were between seven and fourteen years. The group was about evenly divided between males and females. The known duration of the disease ranged from about ten weeks to well over two years. Acute lymphatic leukemia was diagnosed in 9 cases. In 1 the diagnosis was acute myeloblastic leukemia, while in the others no specific cell type was established. In all instances, characteristic roentgenographic changes were noted in the extremities. Necropsy observations were made in 7 cases. The radiographic changes noted in the vertebrae included diffuse demineralization of the bodies, the neural arches, and the transverse processes. The loss of bone density appeared to be more pronounced in the thoracic and the upper lumbar spine. In 6 of the children, this demineralization was greater in the centers of the vertebrae than at their peripheries. Varying degrees of compression of the vertebral bodies were observed, the most common structural change being anterior wedging. In some infants the anterior venous sinuses in the middle and lower thoracic vertebrae were widened. Thinning and breaking of the cortical margins were occasionally seen, but these features were better demonstrated on postmortem roentgenograms of vertebral slabs. Of particular interest were horizontal zones of radiolucency at the upper and lower aspects of the vertebral bodies, corresponding to similar zones at the ends of the long bones. This is considered to be analogous to the disturbances of endochondral growth in the extremities, inasmuch as the vertebral epiphyses are at the cephalic and caudal aspects (2).

Journal

Radiology – Radiological Society of North America, Inc.

Published: Jan 1, 1957

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