Monostotic fibrous dysplasia involved in cervical vertebrae

Fibrous dysplasia (FD) was firstly reported by Lichtenstein in 1938 and can be divided into two main kinds of subtypes: monostotic fibrous dysplasia (MFD) and polyostotic fibrous dysplasia (PFD) with or without endocrinopathy. MFD involved in cervical vertebrae is extremely rare. Two special cases of MFD involved in cervical vertebrae were treated by anterior surgical resection and fusion with instrumentation. In addition, the relevant literatures were reviewed and the characteristics of 13 MFD cases (including two case in our study) involved in cervical vertebrae were also summarized. Neither clinical symptoms nor signs of tumor recurrence were detected in our two cases at the last follow-up. The main presenting symptoms were neck pain, posttraumatic, pathologic fracture, painful torticollis, and incidental finding. The treatment methods included: biopsy/observation, corpectomy with instrumented fusion, posterior fusion, vertebroplasty, curettage and bone graft and complete removal with a combined anterior and posterior fusion procedure. Outcomes of these patients have been uniformly good with a mean follow-up time of 3.65 years (six months to 20 years). Histopathological examination is critical for the diagnosis of FD. Whether, when and how to treat a FD involved in cervical vertebrae still remains controversial. Surgical intervention is indicated if there is a mechanical reason for the pain or a cervical instability or even a compromise of neurological structures. There is no gold standard in operative treatment method and each treatment should be individualized.