Solitary lumbar osteochondroma presenting with spinal cord compression

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.

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.

Retrofibular osteochondroma with peroneal tendon subluxation

Osteochondroma of the bone can cause a range of complications involving tendons, joints and neurovascular structures. Distal fibular osteochondroma and non-traumatic peroneal tendon subluxation are both rare. In this case report, we describe an unusual case of distal retrofibular osteochondroma in a 36-year old male causing peroneal tendon subluxation. He presented with pain and instability around his ankle, but with no history of trauma. He successfully underwent osteochondroma excision, peroneal groove deepening and a Brostrom-Gould type reconstruction for the lateral ankle ligament insufficiency. Complete resolution of the symptoms of instability and subluxation was noted upon 6-month follow up.

Solitary C1 spinal osteochondroma causing vertebral artery compression and acute cerebellar infarct

Osteochondroma is a common benign bone lesion, usually involving the long bones. Spinal involvement is rare. The clinical presentation of spinal osteochondroma varies according to the site of the lesion. The most common reported clinical presentation is secondary to encroachment of the lesion on the spinal canal or nerve roots. Less common presentations such as a palpable neck mass, dysphagia, sleep apnea, paralysis of left vocal cord or acute respiratory distress have been reported when the lesions compress the anatomic structures anteriorly. We describe a rare case of a young patient who presented with an emergent critical condition of acute cerebellar infarct as a result of vertebral artery compression caused by a solitary C1 spinal osteochondroma.