Imaging of chronic recurrent multifocal osteomyelitis of childhood first presenting with isolated primary spinal involvement

Abstract

The initial patient had thoracic T6 and T8 vertebra plana. Bone scan showed additional vertebral body involvement. Follow-up was available over a 3 year period. The second patient had partial collapse of T9 and, 2 years later, of C6. Subsequently extensive multifocal disease ensued and follow-up was available over 8 years. The third patient initially had L3 inferior partial collapse and 1 year later T8 involvement with multifocal disease. Follow-up was available over 3 years. The imaging findings of the three patients include partial and complete vertebra plana with a subchondral line adjacent to endplates associated with bone marrow MR signal alterations. Awareness of the imaging appearances may help the radiologist to include this entity in the differential diagnosis in children who present with spinal pathology and no history of trauma. Histopathological examination excludes tumor and infection but with typical imaging findings may not always be necessary.

Spinal involvement in chronic recurrent multifocal osteomyelitis (CRMO) in childhood and effect of pamidronate

“…Median follow-up was 4.2 years (range, 2.2-7). The total number of vertebral bony lesions on MRI was 72 with a median of 2.6 lesions per patient (range, [1][2][3][4][5][6][7][8][9][10][11][12]. The number of spinal sites affected was as follows: cervical, 9 (13%); thoracic, 43 (60%); lumbar, 6 (8%); and sacral, 14 (19%).…”

“…This underscores the necessity to perform whole body radiological investigations, either using technetium scintigraphy in combination with radiographs or whole body MRI, to enable early diagnosis and allow appropriate follow-up of axial involvement.The clinical significance of spinal involvement in CRMO is demonstrated by the fact that 22% of our patients (6 of 27) had scoliosis or kyphosis as a complication requiring orthopedic corset treatment. Skeletal deformities with fractures and vertebra plana in the growing skeleton causing persisting impairment are reported in several studies [1,3,8,10,15,17,20,21,35,40]. The effectiveness of NSAID in CRMO is beyond dispute, but indications for second line agents are less clear.…”

Chronic recurrent multifocal osteomyelitis with an atypical presentation in an adult man

“…The spinal involvement seen in this patient is rare, and in a review of 35 cases of 157 lesions, only 3 % were present in vertebral bodies [8]. However, initial presentation with isolated vertebra plana or other primary spinal involvement has been previously described in children, although not in adults [9]. Systemic symptoms, although possible, are not common.…”

Chronic Non-Bacterial Osteitis/Chronic Recurrent Multifocal Osteomyelitis

“…Initial presentation with primary spinal involvement has been reported to occur in only about 3% of patients with classic CRMO (Anderson, Heini et al 2003), but vertebral lesions accompany other bone lesions in up to 24% of CNO patients at initial presentation (Jansson and Grote 2011). Typically patients complain of localized back pain, but can also present with anterior chest pain from referred pain.…”

“…All vertebrae from the mid-cervical spine to the sacrum can be potentially affected. A characteristic MRI finding is a subchondral endplate fracture-like line associated with increase in signal in the vertebral marrow (Anderson, Heini et al 2003). Multifocal disease is common, with spontaneous healing and new lesions presenting over a period of years.…”