Eosinophilic granuloma of the skeleton is rarely reported in the literature. The incidence of vertebral involvement varies between 7.8 and 25% and it is generally a solitary lesion, with a predilection for the male sex in the first decade of life. The prognosis is favorable also for the vertebral body's tendency for reconstruction. A recovery of the somatic structure is apparently much improved by eliminating or reducing mechanical stress by means of bed rest and the use of plaster casts or braces. We examined nine patients treated at the Orthopedics Clinic of Padova University, and with a follow-up of > or = 10 years. treated with plaster casts and spinal orthoses. The study was based on the modified Nesbit radiographic classification in 4 grades of severity depending on the height of the vertebral body involved. Long-term follow-up revealed no painful symptoms and a virtually total recovery of somatic structure in five cases, whereas four patients still showed a varying degree of somatic alteration. The osteogenic capacity of the intact ring epiphysis and ossifying metaplastic processes were assumed to be the mechanisms contributing, together with a reduced mechanical load, to reconstruction of the vertebral somatic structure.