Solitary osteochondroma of the lower cervical spine

Medullary Compression by a Cervical Osteochondroma in a Patient with Multiple Hereditary Exostoses: A Case Report

CASE

A 19-year-old man with Multiple Hereditary Exostoses presented with cervical pain without neurological symptoms and/or signs. Magnetic resonance revealed a large C2 osteochondroma, occupying a part of the medullary canal. He was submitted to an en bloc resection with hemilaminectomy without fusion. At the 1-year follow-up, he presented resolution of pain and no neurological symptoms or signs, without cervical instability or radiological signs of disease recurrence.

CONCLUSION

Cervical osteochondroma is usually asymptomatic. Neurological compression and differentiation to chondrosarcoma are the main concerns. Surgical excision allows the local cure of the disease and is usually performed without fusion.

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.

Prospective spine at risk program for prevalence of intracanal spine lesions in pediatric hereditary multiple osteochondromas

STUDY DESIGN

Retrospective cohort study OBJECTIVES: To determine prevalence of hereditary multiple osteochondromas (HMO) and utility of MRI surveillance in a prospective Spine at Risk (SAR) program. Unidentified intraspinal exostoses in HMO can lead to neurologic injury in children during sedated procedures but no MRI guidelines exist. We sought to determine the prevalence and age of intraspinal exostoses from MRIs, and indications for MRI surveillance.

METHODS

Retrospective review was performed of pediatric HMO patients who underwent total spine MRIs at a single institution after a prospective SAR program was instituted. Charts were reviewed for MRI indication and findings, symptoms, surgery, and location of other exostoses. Fisher's exact test was used to compare categorical variables and T test to compare continuous variables. Predictive value of pelvic/rib exostoses was calculated for intraspinal lesions.

RESULTS

Forty-three patients with HMO underwent total spine MRIs with average age of 11.5 years. Fifteen (35%) patients had exostoses on vertebral column, eight (19%) had intra-canal spinal exostoses. Higher prevalence of spine lesions occurred in symptomatic patients than asymptomatic (any spinal lesion: 73% prevalence in symptomatic vs 22% in asymptomatic, p < 0.005; intra-canal spinal lesion: 46% vs 9%, p < 0.05). Only two of the 11 'symptomatic presentations' could be attributable to intracanal spinal exostoses. Only one intra-canal exostosis found on asymptomatic surveillance was treated surgically. Presence of pelvic or rib exostoses were not strongly predictive of intra-canal lesions (23% PPV, 85% NPV, 63% sensitivity, 51% specificity).

CONCLUSIONS

Even with the presence of intra-canal exostoses, true symptomatic lesions are rare. Rib and pelvic lesions were not predictive of intra-canal lesions in our population. We recommend obtaining MRIs at time of preoperative evaluation in asymptomatic children old enough to not need sedation, or in patients with true neurologic symptoms to prevent unnecessary sedation of younger children for surveillance MRI.

LEVEL OF EVIDENCE

III.

Cervical myelopathy due to a solitary osteochondroma: a case report

Introduction

Osteochondroma is the most common benign bone tumor. However, the incidence of osteochondroma in the spine is reported to be very rare.

Case description

This report presents the case of a 57-year-old man who suffered from osteochondroma of the cervical spine. He had bilateral lower extremity pain for 3 years, developing pain of right upper extremity and gait disturbance. Plain radiographic images and computed tomography scans showed bony lesion in right C6/7 foramen and C6 lamina. Magnetic resonance images of whole spine showed severe compression of spinal cord at the C6/7 and spinal canal stenosis at the L3/4 level. First, we performed a surgery of the cervical spine, and removed the tumor covered with the cartilaginous cap. The pathological diagnosis of the tumor was osteochodroma. After the surgery, the symptoms on his right upper extremity improved smoothly. Because the bilateral lower extremity pain remained, a L3/4 partial laminectomy was performed 1 month later, and the symptom improved. At 1 year after his primary operation, we could not find a recurrence of the tumor.

Conclusions

It is very important to perform a complete en bloc resection of the tumor (especially cartilaginous cap) to prevent the recurrence.

Subclinical cervical osteochondroma presenting as brown-sequard syndrome after trivial neck trauma

Osteochondroma is a rare condition in the spine that may be indolent due to its slow growth. The authors present a case of 32-year-old man with subclinical osteochondroma in the cervical spine presenting as Brown-Sequard syndrome after trivial neck trauma. After resection of the tumor through hemilaminectomy, his symptoms were improved with mild residual sequelae.

[Cervical cord compression by hereditary multiple exostosis: case report and review of literature]

BACKGROUND

Hereditary multiple exostosis (HME) is an hereditary disease, characterized by the presence of multiple osteochondromas; 7% of patients with HME have a spinal disease. Through this observation, the authors discuss the diagnostic and therapeutic aspects of this rare lesion.

CASE REPORT

A 45-year-old woman, operated 10 years ago for an exostosis of the right fibula and left femur. She has since few years paresthesia of all four limbs with distal predominance, walking fatigability kind of spinal claudication. The MRI shows a voluminous osteoma at the second cervical vertebra compressing the spinal cord. The patient was operated with macroscopically complete resection of the exostosis and C2 laminectomy.

CONCLUSION

The cervical exostosis associated with HME is a rare disease. The clinical symptomatology is dominated by spinal cord compression and surgical treatment allows excellent clinical results.

Spinal osteochondroma: a report on six patients and a review of the literature

INTRODUCTION

Osteochondromas are the most common benign tumour of the bone. They occur in two forms as solitary and hereditary multiple form. Osteochondromas are generally located on the metaphysis of the long bones. From 1 to 4% of osteochondromas occur in the spine. Spinal osteochondromas can cause cord and root compression and also be asymptomatic. In the diagnosis of osteochondromas, radiological methods are very important.

PURPOSE OF STUDY

Because spinal osteochondroma is very rare, other benign and malign tumours should be kept in mind during differential diagnosis. In this paper, six patients with spinal osteochondral lesions were evaluated at our orthopaedic oncology department.

PATIENTS

Between 1986 and 2009, six patients, four males, two females with an average age of 31.2 (9-65) were diagnosed with spinal osteochondroma at our clinic. Although one patient was diagnosed following another complaint, five patients were suffering from pain. In addition, four patients had swelling and one patient had neurological symptoms. Five patients were treated surgically, and the sixth one was followed conservatively.

DISCUSSION

The patients with spinal osteochondral lesions applied with mostly pain and swelling at the dorsal of the vertebrae. Because neurological symptoms are rarely seen, radiological examination is of great importance in diagnosis.

CONCLUSIONS

Patients suffering from spinal osteochondroma, due to the risk of secondary chondrosarcoma, must be closely evaluated both clinically and radiologically. If necessary, the patient must be treated surgically following histopathological diagnosis.

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.

Involvement of the spine in patients with multiple hereditary exostoses

BACKGROUND

Extension of a vertebral exostosis into the spinal canal is rare, but many isolated cases have been reported in the literature. Three existing patients with multiple hereditary exostoses at our institution had development of neurologic findings and were found to have exostoses in the spinal canal. These findings led us to perform magnetic resonance imaging or computed tomographic scans for the remaining patients with multiple hereditary exostoses at our institution.

METHODS

Forty-four patients at our institution (including twenty-six male patients and eighteen female patients) had multiple hereditary exostoses. Forty-three patients were evaluated with magnetic resonance imaging and one was evaluated with computed tomography to look for spinal column involvement.

RESULTS

Thirty (68%) of the forty-four patients had exostoses arising from the spinal column, and twelve (27%) had lesions encroaching into the spinal canal. Thirty-six of the forty-four patients also had plain radiographs, but only six had radiographs that accurately identified the lesions and another six had radiographs that mistakenly identified lesions that were not confirmed with magnetic resonance imaging or computed tomography. Patients with lesions inside the spinal canal were typically asymptomatic and neurologically normal, with radiographs that did not demonstrate the lesion. Compared with female patients, male patients were more likely to have spinal lesions and more likely to have lesions encroaching into the spinal canal (p = 0.014).

CONCLUSIONS

The risk that a patient with multiple hereditary exostoses has a lesion within the spinal canal is much higher than previously suspected (27%). Because the potential exists for serious neurologic injury to occur, we have begun to use magnetic resonance imaging to screen all patients who have multiple hereditary exostoses at least once during the growing years.

Spinal osteochondroma: spectrum of a rare disease

✓Osteochondromas are the most common benign bone tumor. Although the metaphysial region of long bones is the usual site of these tumors, the vertebrae may be infrequently affected. The presentation may vary from typical compressive myelopathy to radiculopathy or radiculomyelopathy, depending on the site of involvement. The authors present 3 consecutive cases of cervical spine osteochondromas encountered over 3 years at their institution, each different in its site of involvement, presentation, and chosen treatment. The patient in Case 1 had the typical presentation and lesion site, and was treated with a conventional laminectomy. The patient in Case 2 presented with an extensive disease that required complex, staged surgery with spinal fusion and instrumentation. The patient in Case 3 presented with monoradiculopathy and had a facet joint osteochondroma that was successfully treated with a simple partial facetectomy, without laminectomy.

Osteochondroma of the cervical spine extending multiple segments with cord compression

Involvement of the cervical spinal cord by a solitary osteochondroma is rare. We describe a case of cervical osteochondroma extending from C5 to C7 in a 16-year-old male. The tumor, arising from the inner aspect of the C6 spinous process, projected longitudinally into the spinal canal and compressed the spinal cord; this caused clinical symptoms associated with myelopathy and radiculopathy. Total excision of the tumor by C5-C7 hemilaminectomy resulted in a good functional recovery.

Spinal exostoses: analysis of twelve cases and review of the literature

STUDY DESIGN

Retrospective review of spinal exostoses treated at our institution and literature review.

OBJECTIVES

Review of 12 cases of spinal exostoses treated at our institution compared with 165 cases of spinal exostoses reported in the literature.

SUMMARY OF BACKGROUND DATA

Spinal exostoses are uncommon. Most reports consist of 1 to 3 cases. The relationship between solitary exostoses and those associated with multiple hereditary exostoses (MHE), as well as the incidence of intraspinal and extraspinal location, symptoms presentation, and results of treatment are unclear.

METHODS

The medical records, operative reports, and diagnostic imaging of 12 patients with spinal exostoses treated at our institution between 1972 and 2002 were reviewed. The literature was reviewed using MEDLINE search of English literature and bibliographies of published manuscripts.

RESULTS

Solitary spinal exostoses were more common than those associated with MHE. Lesions were most common in the upper cervical spine and originated from the posterior elements. Patients with exostoses associated with MHE were significantly younger and had a higher incidence of symptoms consistent with neural structure compression than patients with solitary exostoses. Complete excision resulted in resolution of preoperative symptoms. Intralesional excision resulted in recurrence in all cases.

CONCLUSIONS

Spinal exostoses are more common than reported previously. Patients with MHE that present with back pain or neurological symptoms should produce a high index of suspicion. Evaluation should include both computed tomography and magnetic resonance imaging to define the origin of the exostosis and the presence of neural structure compression. Surgical excision should be preformed en bloc.

Spinal osteochondromas in middle-aged to elderly patients

STUDY DESIGN

Three case reports of solitary spinal osteochondromas in middle-aged and elderly patients.

OBJECTIVES

To describe the treatment of three rare cases of spinal osteochondromas in patients significantly older than the cases previously reported in the literature.

SUMMARY OF BACKGROUND DATA

Osteochondromas arising in the vertebral column are considered rare. The mean age of clinical appearance is said to be in the second or third decade of life.

METHODS

Clinical history, physical examinations, plain radiographs, magnetic resonance imaging, myelography, computed tomographic myelography, and histopathologic findings for each case were reviewed in conjunction with previous cases reported in the literature.

RESULTS

Total removal of the tumor was effective in causing the symptoms to disappear.

CONCLUSIONS

Spinal osteochondromas are rare and tend to appear in young adults. Three cases of spinal osteochondromas that were unusual in terms of age at clinical presentation and localization were reported, suggesting a continuous growth of the tumor beyond skeletal maturity.