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Journal of Chalmeda Anand Rao Institute of Medical Sciences Vol 6 Issue 1 November 2013 ISSN (Print) : 2278-5310 70

Osteochondroma of Cervical Spine

causing Spinal Cord Compression

Masthan Reddy A1, Bhasker G1, Anil Kumar T2, Lakshman Rao A3,

Sandeep M4

1Assoc. Professor1Professor2, 3Asst. Professor4PG StudentDepartment of Neurosurgery,Osmania General Hospital,Hyderabad, Andhra Pradesh,India

CORRESPONDENCE:

1Dr. A. Masthan Reddy,MS,Mch (Neurosurgery)Associate ProfessorDepartment of Neurosurgery,Osmania General Hospital,Hyderabad,Andhra Pradesh – 500012,India.E-mail:amreddy.neuro@gmail.com

Case Report

INTRODUCTION

Osteochondromas are common benign tumours of bonethat often occur in the metaphysodiaphyseal parts of longbones. Besides the more common solitary form, some aremultiple when associated with hereditary multipleexostosis, an autosomal dominant trait. [4, 6]

Osteochondromas rarely occur in the spine. [1, 3, 5, 8] Spinalcord or root compressions have been reported as a rarepathological condition. They may cause neurologicalsymptoms as a result of compression of the spinal cordor nerve roots.[7, 8, 9] Complete surgical excision of thetumour results in definitive cure.[1, 10, 11] We present a caseof osteochondroma arising from the C3 vertebral lamina,causing neurological symptoms, in view of the rarity ofthe condition and should be thought of in the differentialdiagnosis of spinal cord compressive myelopathy.

ABSTRACT

A report of a patient with osteochondroma of the upper cervical spine causing cervicalcompressive myelopathy. The surgical treatment of this patient involved the completeremoval of tumor and decompression of neural structures. Osteochondromas affect mostlythe long bones. Involvement of spine by solitary osteochondromas is a rare condition.The present report represents a case of spinal osteochondroma causing neurologic symp-toms. Cervical osteochondromas causing cord compression, best evaluated by routinemagnetic resonance imaging and noncontrast computed tomography scans, rarely con-tribute to cervical nerve root compression. The patient’s symptoms gradually resolvedafter gross total tumour removal. Symptomatic spinal osteochondromas are rare occur-rences in an individual surgeon’s experience. Computed tomography or magnetic reso-nance imaging are the procedures of choice. In the majority of patients with myelopathyor radiculopathy, surgery results in complete relief of symptoms as demonstrated in thiscase.

Keywords: Osteochondroma, spinal cord compression, cervical spine.

CASE REPORT

A twenty-year-old male patient presented withcomplaint of neck pain of six months duration. Pain wasdull aching, increased during night time and on lyingdown posture and during neck movements. Pain was notrelieved with medication. Pain was associated withweakness of right hand and parasthesias. Patient wasunable to hold the pen and write for long time. Since onemonth there is stiffness of the right lowerlimb. No historyof bowel and bladder incontinence. On examination therewas right hand grip weakness and 4/5 power ondorsiflexion of right wrist. Reflexes are exaggerated onright half of body with upgoing plantar. There was gradedsensory loss from C4- C7 dermatome to touch and painon right side. Neck movements are restricted. There wastenderness against C4- C5 spinous process. MRI showeda solitary bony projection arising from the C3 vertebral

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A Masthan Reddy et.al:

Figure 2A : Low power resolution showing cartilaginous cap in

continuous with bony trabeculaeFigure 2B : High power resolution showing cartilaginous cap

Figure 3 : Post operative CT Scan film showing post laminectomy

with total excision of the lesion

Figure1 : T2W1 image showing bony projection arising from C3 vertebral arch causing severe cord compression

lamina on right side extending into the spinal canalcausing severe cord compression. [Figure 1]Hematological and biochemical parameters were withinnormal limits.

The lesion was explored through a posterior approach inmidline. The mass was bony hard involving the neuralarch of C3 on right side. C3 and partial C4 laminectomywas done. Total excision of tumour done, completelyclearing the spinal cord compression. Histopathologyshowed cartilaginous cap in continous with bonytrabeculae and intervening bone marrow cells, suggestiveof osteochondroma. [Figure 2] Neck pain resolved in thecourse of first post operative week. Post operative CTrevealed that decompression was complete with noresidual mass. [Figure 3] At the end of three monthspatient was self ambulatory and motor power improvedto 4+/5. There was no recurrence at the end of one year.

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DISCUSSION

Osteochondroma, also called exostoses are the mostcommon benign tumors of the bone. Osteochondromasaffect mostly the long bones, particularly the distal femurand tibia. While the rate of solitary osteochondromasarising from the spine is 1.3- 4.1% in the literature,involvement of the spine in hereditary multiple exostosisis 7.9%.[1, 3, 5, 6] In the study of Albrecht et al on spinalosteochondroma, 505 of the subjects showed cervicalinvolvement, with C2 being the most affected vertebra.Spinal osteochondromas more commonly arise from theposterior arch but they may arise from the vertebral body,pedicle or rarely from the facet joints as well. [5, 6]

Patients consulting for pain or presence of a local massmay often show early signs of neurological deficits.[9,11]

Khosla et al reviewed the literature and reported that of72 cases of spinal solitary osteochondroma, 37 had spinalcord compression. An increased incidence of spinal cordcompression has been reported in hereditary multipleexostosis cases when compared with solitaryosteochondroma. Mean age at presentation ranged from13- 45 years (mean 25.3years). [13] The clinical featuresdepend on the site of involvement and present withradiculopathy, myelopathy, or myeloradiculopathy.Magnetic resonance imaging is useful in localizing thelesion, [5, 9] along with X-ray and CTscan.

No treatment is necessary for an asymptomatic spinalosteochomdroma. If the lesion is causing pain orneurological symptoms due to compression it should beexcised at its base. As long as the entire cartilage cap isremoved, there should be no recurrence. [4, 6]

Total excision of tumour with decompression of neuralelements is the treatment of choice for intraspinalosteochondromas. [1, 2, 7-12]

CONCLUSION

Osteochondromas, the most common tumoral lesions ofthe skeletal system, may rarely involve the vertebra.Symptomatic spinal osteochondromas are rareoccurrences in an individual surgeon’s experience. Theselesions particularly occur in the cervical region and shouldbe considered in the differential diagnosis, when

confronted with an expansile mass. MRI imaging candiagnose spinal cord compression. Excision of the lesionsis necessary for the treatment of neurologicalcompression. Surgery results in complete relief ofsymptoms as demonstrated in this case.

REFERENCES

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Osteochondroma of Cervical Spine