Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with localized spinal pain, often insidious in onset, localized to the affected vertebral level. History may include recent onset of restricted range of motion, localized tenderness, or incidental discovery of vertebral collapse (vertebra plana) on imaging. Absence of systemic B-symptoms (fever, night sweats, weight loss) is noted, though mild localized inflammatory symptoms may be present.
Clinical Examination Findings
Physical examination reveals localized paraspinal muscle spasm and tenderness to palpation over the affected spinous process. Neurological examination is typically intact, though focal deficits should be assessed if significant vertebral collapse is present. Gait may be antalgic due to pain. Careful inspection for cutaneous lesions (seborrheic-like rash) is performed as part of the systemic LCH screening.
Treatment Protocol
Management strategy focuses on symptomatic relief and monitoring for vertebral re-expansion. Options include observation for asymptomatic lesions, bracing for pain control and stability, or intralesional corticosteroid injection. Surgical intervention (decompression/stabilization) is reserved for cases with neurological compromise or severe spinal instability. Bisphosphonates may be considered for refractory pain.