Cervical osteochondroma

A 34-year-old man with hereditary multiple exostoses presented with gradual tetraparesis. Neuroimaging evaluation revealed an important posterior spinal cord compression by a C3 bony formation. Following posterior microsurgical decompression, the patient recovered nearly completely. Histopathological examination of the intraspinal lesion confirmed the diagnosis of benign osteochondroma. The patient returned to a normal life without evidence of recurrence at 2-year follow-up ¹⁾.

Lee et al. report a case of a solitary osteochondroma as a dumbbell tumor compressing the spinal cord and its surgical strategy. The patient is a 16-year-old female with longstanding posterior neck pain and left arm abduction weakness. She was examined by plain X-ray, three-dimensional-computed tomography, magnetic resonance imaging, and vertebral angiography. The analyses indicated a calcified extradural mass compressing the cord in the C3-4 portion extending into the neural and vertebral foramen with eroded vertebral body. The tumor was successfully excised using a modified combined anterior and posterior approach. Histopathologic study of the resected material confirmed the diagnosis. The postoperative assessment was followed by clinical and radiologically therapy for 5 years after surgery. Osteochondroma arises from enchondral bone but it rarely involves the spine, especially not as s dumbbell type. In this patient, the tumor may have arisen from the neural arch and extended into the extradural and extraforaminal space over a long period. We successfully removed the dumbbell tumor with a combined anterior oblique and posterior approach. However, further observation is essential because of the possibility of recurrence and sarcomatous change ²⁾.

A 8-year-old girl who experienced myelopathy due to spinal compression of the cervical osteochondroma. This case suggests that if a cartilage cap is observed on the spinal canal with magnetic resonance imaging (MRI), the tumor may extend to the spinal canal, resulting in neurologic dysfunction. Therefore, careful follow-up until bone maturity should be performed ³⁾.

A case of vertebral osteochondroma arising from the lamina of C3 vertebra, presenting with features of compressive myelopathyin a 15 year old boy.Total excision of the tumor was carried out along with lamina of C3 vertebra.Patient recovered significantly.

Spinal osteochondromas must be considered as rare etiology of spinal cord or root compression in the pediatric age group and utmost care should be taken while excising these benign lesions ⁴⁾.

Lotfinia et al. present a case of solitary osteochondroma arising from the posterior arch of C1, causing left-sided ascending numbness and paresthesia and difficulty walking. The lesion was totally resected through a posterior approach. Histopathological examination confirmed the diagnosis of benign osteochondroma.

Spinal cord compression is uncommon in spinal osteochondromas because in most cases the tumor grows out of the spinal column. To prevent neurological compromise, complete surgical removal is mandatory when an intraspinal osteochondroma with cord compression is diagnosed, which also helps to prevent recurrence. Our literature review of similar cases indicates that despite the old belief that C2 is the most commonly involved vertebra for osteochondromas, C1 is actually the most commonly involved vertebra in the cervical region ⁵⁾.

Veeravagu et al. report 2 adult patients, both with a history of hereditary multiple exostoses, who presented with cervical myelopathy secondary to osteochondromas. The first patient is a 22-year-old man with numbness and weakness of his right upper limb and neck pain. Radiologic images showed a bony tumor arising from the C3 lamina with evidence of severe spinal cord compression. The second patient is a 20-year-old woman with weakness of her left upper and lower limbs and progressive numbness of the left hand, as well as neck and back pain. Radiologic images showed a bony tumor arising from the C4 lamina with evidence of significant spinal cord compression and cord signal abnormality. Both patients underwent surgical excision of the epidural mass and pathology confirmed a diagnosis of osteochondroma.

They discuss the role of surgical intervention, management, and postoperative follow-up in adult patients with cervical osteochondromas. Recommended management includes radiographic imaging and surgical intervention, particularly when evidence of spinal cord impingement occurs. Consistent postoperative follow-up is necessary to ensure appropriate recovery of neurologic function. Surgical management of cervical osteochondromas typically results in excellent and stable clinical outcomes with rare recurrence ⁶⁾.

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.

It is very important to perform a complete en bloc resection of the tumor (especially cartilaginous cap) to prevent the recurrence ⁷⁾.