Tetraparesis due to exostotic osteochondroma at upper cervical cord in a patient with multiple exostoses–mental retardation syndrome (Langer–Giedion syndrome)

Osteochondroma Arising From the Inferior Articular Process of the Lumbar Spine in a Geriatric Patient: A Case Report and Literature Review

Objective

Spinal osteochondromas are rare, and approximately less than 5% occur as spinal lesions. We report the case of a solitary osteochondroma of the spine and review and update the literature on spinal osteochondroma, including surgical treatment and subsequent results.

Case Description

A 73-year-old female patient complained of a 10-year history of back pain and a 4-year history of right-side lower extremity radiating pain with paresthesia. Computed tomography and magnetic resonance imaging (MRI) revealed a bony mass arising from the inferior articular process (IAP) of L3, presenting with features of compressive spinal stenosis at the L3–L4 level. The treatment strategy included the complete marginal excision of the lesion through the posterior approach, as well as complete decompression of the spinal canal and nerve roots. The patient’s symptoms resolved after surgery, and histopathological examination identified the lesion as an osteochondroma.

Review Results

This review study included 168 solitary osteochondroma cases. The most commonly involved spinal level was cervical (51.8%), and the most frequent spinal anatomic column involved was the posterior column (70.8%). Radiculopathy accounted for 30.3% of all cases, myelopathy accounted for 31.0%, and 7.7% exhibited both symptoms simultaneously. The recurrence rate was 6.0%.

Conclusion

Computed tomography and MRI can effectively diagnose spinal osteochondroma, and surgical treatment can effectively improve clinical outcomes. In almost all symptomatic cases, the best treatment is marginal excision of the tumor. Complete resection of the cartilaginous cap of the tumor is especially important to prevent recurrence.

Diagnosis, Management, and Treatment Options: A Cervical Spine Osteochondroma Meta-Analysis

Osteochondroma is described as a capped benign bony neoplasm that forms on the outer surface of bone. These tumors affect nearly 6 million people per year. Although osteochondromas most often involve the appendicular skeleton, many involve the spine, with many cases located in the cervical spine. When osteochondromas involve the spine, they can present with a variety of symptoms, including pain, radiculopathy, and myelopathy, which may necessitate surgical treatment. Spinal osteochondromas can be classified into 2 types: multiple osteochondromas in the context of patients with multiple hereditary exostosis (MHE) and solitary osteochondroma or solitary exostosis (SE). Previous reviews have captured only some of the available literature on cervical osteochondromas and have generally focused on either SE or those associated with MHE. The purpose of our review was to provide an extensive review of all previously reported cervical osteochondromas and to compare osteochondroma characteristics, clinical presentation, and outcomes in the context of MHE and SE.

Solitary Osteochondroma of the Spine-A Case Series: Review of Solitary Osteochondroma With Myelopathic Symptoms

STUDY DESIGN

Case series and literature review.

OBJECTIVE

There is a growing body of literature supporting that osteochondroma of the spine may not be as rare as previously documented. The purpose of this study was to perform an updated review and present our experience with 4 cases of solitary osteochondroma of the spine, including surgical treatment and subsequent outcomes.

METHODS

A review of 4 cases and an updated literature review.

RESULTS

All 4 cases were diagnosed as solitary osteochondroma of the spine based on clinical and histopathologic findings. Majority of the lesions arose from the posterior column with one case showing extension into the middle column with clinical neurologic sequelae. Treatment strategies for all cases included complete marginal excision of the lesions using a posterior approach. All 4 cases showed no radiographic evidence of recurrence. The literature review yielded 132 cases of solitary osteochondroma and 17 case associated with multiple hereditary exostosis. Out of the 132 cases, 36 presented with myelopathic symptoms.

CONCLUSION

Osteochondroma of the spine may not be as rare as previously reported. The best approach to treatment in almost all symptomatic cases include wide surgical excision of the tumor. This should include complete resection of the cartilaginous cap of the tumor in an effort to prevent recurrence. When excision is performed properly, the outcomes are excellent with very low recurrence of the tumor.

Long-term follow-up of four patients with Langer-Giedion syndrome: clinical course and complications

Long-term observations of individuals with the so-called Langer-Giedion (LGS) or tricho-rhino-phalangeal type II (TRPS2) are scarce. We report here a on follow-up of four LGS individuals, including one first described by Andres Giedion in 1969, and review the sparse publications on adults with this syndrome which comprises ectodermal dysplasia, multiple cone-shaped epiphyses prior to puberty, multiple cartilaginous exostoses, and mostly mild intellectual impairment. LGS is caused by deletion of the chromosomal segment 8q24.11-q24.13 containing among others the genes EXT1 and TRPS1. Most patients with TRPS2 are only borderline or mildly cognitively delayed, and few are of normal intelligence. Their practical skills are better than their intellectual capability, and, for this reason and because of their low self-esteem, they are often underestimated. Some patients develop seizures at variable age. Osteomas on processes of cervical vertebrae may cause pressure on cervical nerves or dissection of cerebral arteries. Joint stiffness is observed during childhood and changes later to joint laxity causing instability and proneness to trauma. Perthes disease is not rare. Almost all males become bald at or soon after puberty, and some develop (pseudo) gynecomastia. Growth hormone deficiency was found in a few patients, TSH deficiency so far only in one. Puberty and fertility are diminished, and no instance of transmission of the deletion from a non-mosaic parent to a child has been observed so far. Several affected females had vaginal atresia with consequent hydrometrocolpos.

Spinal stenosis frequent in children with multiple hereditary exostoses

PURPOSE

Children with multiple hereditary exostoses (MHE) have numerous osteochondromas, with the most prominent lesions typically over the appendicular skeleton. A recent report noted a high rate of intracanal lesions in this patient population and recommended preventative spinal screening with magnetic resonance imaging (MRI) or computed tomography (CT). We sought to evaluate the prevalence of spinal stenosis from intracanal osteochondromas at our pediatric orthopedic center in order to evaluate if routine screening is warranted.

METHODS

All pediatric patients treated for MHE were retrospectively identified. Records were reviewed to determine demographics, previous orthopedic surgery, and indication and results of axial spine imaging (CT or MRI). Imaging studies were reviewed to evaluate the presence of intracanal and compressive spinal lesions.

RESULTS

Between 1990 and 2011, axial imaging was performed in nine patients with MHE due to concerns of pain, weakness, and/or dizziness. These patients had moderate disease involvement, with a mean of 4.9 previous orthopedic surgeries to address skeletal osteochondromas. Two patients with MHE had cervical spinal stenosis secondary to intracanal osteochondromas. Both children successfully underwent spinal decompression. Thus, of our MHE population undergoing axial imaging, 22 % were noted to have intracanal lesions.

CONCLUSIONS

Our experience reveals a >20 % rate of compressive intracanal osteochondromas in MHE patients undergoing spinal imaging. These two patients represent 5 % of the MHE patients treated at our center. These lesions may be slow growing, and significant consequences can occur if not identified promptly. Thus, we confer that routine axial screening of the spinal canal may be warranted in these children.

Neurological manifestations, imaging characteristics, and surgical outcome of intraspinal osteochondroma

OBJECT

Spinal osteochondromas (OCs) are rare and can originate as solitary lesions or in the context of hereditary multiple exostoses. Concurrent spinal cord compression is a very rare entity. The purpose of this study was to evaluate the authors' 10-year experience with the imaging characteristics and surgical outcome in patients with symptomatic spinal OC.

METHODS

Between 1997 and 2007, 8 consecutive cases of symptomatic intraspinal OC with documented spinal cord compression were treated surgically. These patients were analyzed with regard to presentation, imaging, and outcome. The relevant English literature was reviewed using MEDLINE and Google search engines.

RESULTS

Three patients had cervical, 2 had thoracic, and 3 had lumbar lesions. Classic MR imaging characteristics were rarely found. Multiple hereditary exostoses were equally responsible for cervical, thoracic, and lumbar lesions (33%). The origin of the lesion was from the pedicle (25%), lamina (25%), vertebral body (25%), and superior or inferior facets (25%). A posterior approach to the spine was used in 6 patients, and a combined anterior and posterior approach with fusion was performed for 2 thoracic lesions. Surgical outcome was satisfactory in 75% of patients. The prognosis was poor in the patients with thoracic lesions.

CONCLUSIONS

In the authors' experience, early detection and surgical removal in cases of symptomatic spinal OC is a key element for the best outcome. Posterior approaches are generally sufficient. The chronicity of symptoms may limit functional recovery postoperatively, especially with cervical and thoracic lesions.

Cervical osteochondroma with postoperative recurrence: case report and review of the literature

INTRODUCTION

Osteochondromas of the cervical spine are rare. We report an 8-year-old girl presenting with neck pain and a known familial predisposition for osteochondromas.

CASE REPORT

Imaging revealed a presumed osteochondroma of the cervical spine located at C3. A cervical hemilaminectomy of the lesion was performed. Histopathology confirmed the lesion as an osteochondroma. Six months later, the child was found to have a recurrence of the previously resected lesion.

CONCLUSION

The child was reoperated and the lesion removed along with the entire remaining lamina of C3. At 6-year follow-up, there has been no recurrence of the child's cervical lesion. We believe this to be the third reported case of recurrence of a cervical osteochondroma. Surgeons dealing with such lesions should be mindful of this complication.

Cervical spinal cord compression due to an osteochondroma in hereditary multiple exostosis: case report and review of the literature

BACKGROUND

Hereditary multiple exostosis is a benign disorder characterized by multiple osteochondromas affecting long and flat bones, although occasionally vertebral column involvement can be seen. Cervical spinal cord compression in HME is a rare condition. The objective of this manuscript is to describe a rare case of cervical myelopathy due to an exostosis arising from C7 in a patient with HME and a comprehensive review of the current literature.

CASE DESCRIPTION

We describe a case of HME in an 18-year-old girl with myelopathy characterized by quadriparesis due to an osteochondroma arising from the lamina of C7. The patient underwent surgery, and a laminectomy was performed with a complete removal of the exostosis and spinal cord decompression. One month after surgery, patient presented an excellent recovery without neurologic deficits.

CONCLUSIONS

Cervical spinal cord compression resulting from osteochondroma is an extremely serious complication of HME. Neurosurgical approach should be recommended in order to achieve a spinal cord decompression, which usually results in excellent functional recovery.