Sarcoidosis of the spine: a report of five cases and a review of the literature.

Sarcoidosis, also called Morbus Boeck disease , is a potentially systemic disease defined by noncaseating granulomatous inflammation of uncertain etiology1. The natural history of sarcoidosis is unpredictable as it can involve one or multiple organ systems and it can be progressive or resolve spontaneously. While sarcoidosis has been described as affecting most organ systems, the lungs are involved in >90% of cases2. Skeletal involvement is much less frequent; the prevalence has been reported to range from <1% to 13%2,3. The small bones of the hands and feet are most often involved, whereas spinal disease is rare4. Most patients with spinal sarcoidosis present with axial pain that resolves either on its own or after the administration of corticosteroids. However, pathologic fractures have been reported with associated neurologic sequelae5,6. We report the clinicopathologic features of five patients with sarcoidosis involving the spine. The Massachusetts General Hospital Institutional Review Board reviewed and approved this study. We searched our bone sarcoma registry to identify all patients diagnosed with sarcoidosis of the spine from 1980 through 2007. In addition, we utilized our Department of Pathology database to search for pertinent cases. Inclusion criteria were the diagnosis of sarcoidosis, confirmed with a bone biopsy of the spine, and a minimum duration of follow-up of two years. The initial group included thirteen patients. One patient was excluded because there was no histological evidence of bone sarcoidosis. We also excluded five patients who had bone sarcoidosis but not of the spine. Two patients were excluded because of a lack of sufficient follow-up. This left a cohort of five patients with sarcoidosis of the spine who formed the final study group, and we reviewed their medical records, radiographs, and pathology reports. The tissue specimen from each case …