Gorham's disease: diagnostic utility of an autopsy for a rare bone disease

Vertebroplasty in a 10-year-old boy with Gorham-Stout syndrome

PURPOSE

To describe our experience using balloon vertebroplasty with polymethylmethacrylate filler in a 10-year-old boy with Gorham-Stout syndrome. Gorham-Stout syndrome is a rare disorder of unknown etiology characterized by intraosseous proliferation of fibrovascular or lymphatic tissue that results in progressive osteolysis and bone destruction. It can affect any part of the skeleton and lead to pathological fractures and muscular weakness or atrophy. The literature contains few reports on the surgical management of vertebral osteolysis with risk of fracture in children. Spinal fusion is the treatment of choice.

METHODS

The patient was asymptomatic until age 10 years, when he began to experience back pain. Annual magnetic resonance scans did not show progression of bone disease. Medical treatment was unsuccessful, and the visual analog scale (VAS) for lumbar back pain was 8-10. Balloon vertebroplasty with polymethylmethacrylate filler was performed at L3 and L4, the vertebrae with an increased risk of pathological fracture.

RESULTS

The postoperative course was uneventful. One month after surgery the VAS was 2-3. Four years later, the patient remains free of procedure-related complications, his clinical situation is stable, and no further low back pain has been reported.

CONCLUSIONS

We report the only application to date of vertebroplasty to treat vertebral osteolysis in a pediatric patient. The outcome and possible complications of this technique remain unknown in children. The patient in the present report underwent vertebroplasty at two levels, and his progress remains satisfactory 4 years after surgery. He has not developed technical complications or changes in spinal growth. Therefore, we propose vertebroplasty for the treatment of vertebral osteolysis in pediatric patients at risk of pathological fracture.