Year : 2006 | Volume
: 1 | Issue : 2 | Page : 70--71
Pediatric spinal osteochondromas: Case report and review of literature
K Sil, S Basu, MK Bhattacharya, S Chatterjee
Department of Neurosurgery, Park Neurosciences Centre, Park Clinic, Kolkata, India
19, Sarat Ghosh Garden Road, Dhakuria, Kolkata - 700 031
Osteochondromas, though common in appendicular skeleton, are a rarity in spine, that too in young age. We present two case reports - one solitary, one multiple - in young age patients and review the literature.
|How to cite this article:|
Sil K, Basu S, Bhattacharya M K, Chatterjee S. Pediatric spinal osteochondromas: Case report and review of literature.J Pediatr Neurosci 2006;1:70-71
|How to cite this URL:|
Sil K, Basu S, Bhattacharya M K, Chatterjee S. Pediatric spinal osteochondromas: Case report and review of literature. J Pediatr Neurosci [serial online] 2006 [cited 2020 Oct 21 ];1:70-71
Available from: https://www.pediatricneurosciences.com/text.asp?2006/1/2/70/27458
Osteochondromas are benign cartilaginous tumors that are commonly found in the appendicular skeleton. Spinal osteochondromas are a rarity, and they are most commonly associated with hereditary multiple exostoses. We present two cases of spinal osteochondromas in pediatric population, presenting differently, and review the existing literature.
A 16-year-old girl presented with intense persistent, progressive left brachialgia for the last 2 years. There were no associated symptoms of gait abnormalities, sphincter disturbance or constitutional problems. On examination, she was found to have hypoesthesia over left C6 dermatome and a palpable, nontender bony hard 2 x 2 cm immobile swelling with regular margins over the left side of the neck. There were no other palpable bony swellings. X-ray, CT scan, MRI and MR angiography revealed a bony tumor arising from C5 and C6 vertebrae at the junction of the bodies with the transverse processes on the left side, compressing the exiting left C5 and C6 nerve roots and in close relation with the left vertebral artery, though not indenting it. The adjacent vertebral bodies of the vertebrae C5 and C6 were ill formed, but there was definite presence of disc space in between them. There was no compression of the spinal cord or evidence of any instability. The tumor was removed by left anterior (Robinson's) approach from under the left longus colli muscle. There was a distinct plane of cleavage between the tumor and the vertebral artery and the sympathetic chain. The patient had immediate relief of symptoms by the time of discharge. At 2 years' follow-up, she is completely symptom free.
A 6-year-old girl was referred to us with features of progressive gait imbalance, lower limb weakness and bladder and bowel disturbance for 3 months. On examination, she had spastic paraparesis with motor and sensory levels of D2-3 and with sphincter involvement. She had multiple bony hard swellings over her body. CT and MRI revealed a bony tumor with cartilaginous component arising from right C6, C7, D1, D2 pedicles, compressing the thecal sac [Figure 1],[Figure 2]. She underwent hemilaminectomies of the involved vertebrae, excision of the tumor and stabilization with Hartshill rectangle. Postoperatively, at 3 months, she had no significant neurological improvement.
Osteochondromas are the commonest bony tumors, accounting for 10-15% of all bony tumors and 20-50% of benign tumors of the bone. They are developmental lesions rather than true neoplasms. Osteochondromas are hyperplastic-dysplastic disturbance of the bone from progressive endochondral ossification. They may be solitary or multiple, the latter being associated with an autosomal dominant syndrome, hereditary multiple exostoses. Osteochondromas comprise of a cortical and medullary bone with an overlying hyaline cartilage cap and must demonstrate continuity with the underlying parent bone. Variants of osteochondromas include subungal exostosis, dysplasia epiphysealis hemimelica, turret and traction exostoses, bizarre parosteal osteochondromatous proliferation and florid reactive periostitis. Malignant transformation is seen in 1% of solitary and 3-5% of hereditary variants.
Spinal osteochondromas are seen in 1-4% of solitary osteochondromas and 7-9% of hereditary varieties. In fact, the occurrence is twice as common in the hereditary variant compared to the solitary group (77% vs. 33%). The demographic pattern as reported in literature reveals that they are more common in males, and the mean age is 20 years in the hereditary variety and 30 years in the solitary subtype. It is rare in the pediatric age group. Radiation-induced osteochondromas of the spine have also been reported. Majority of spinal osteochondromas are asymptomatic, and features of spinal cord or root compression are seen in few. The mean time for symptomatic presentation was reported as 3.9 years. In the neural arch, which is the commonest site of origin, the compression is usually from the posterolateral side, though rarely cases with anterior compression are reported in the literature. CT and MRI are both complementary in diagnosis; while the MRI reveals the extent of cord compression and the cartilaginous part of the tumor, CT scan defines the bony extent. The features typical of osteochondroma in a spinal CT scan are a) roundish, sharply outlined mass, b) bone-like density with scattered calcification, c) paraspinal dumbbell or eccentric intraspinal location, d) osteosclerotic changes in neighboring bone and e) lack of contrast enhancement. Surgical treatment improves the neurodeficit in 81% of the cases, and recurrence is seen in only 4% of cases on long-term follow-up.
Our cases were unique in that the patients were very young, all of them were females and they presented differently with radiculopathy and myelopathy respectively. One had multiple exostoses, and in the other the spinal osteochondroma was solitary. Surgical treatment was not effective in reversing the neurodeficit in one case.
Spinal osteochondromas are to be remembered as rare etiology of spinal cord or root compression in the child and adolescent.
|1||Murphey MD, Choi JJ, Kransdorf MJ, Flemming DJ, Gannon FH. Imaging of osteochondroma: Variants of and complications with radiologic-pathologic correlation. Radiographics 2000;20:1407-34. |
|2||Khosla A, Martin DC, Awwad EE. The solitary intraspinal vertebral osteochondroma. An unusual cause of compressive myelopathy: Features and literature review. Spine 1999;24:77-81.|
|3||Govender S, Parbhoo AH. Osteochondroma with compression of the spinal cord. A report of two cases. J Bone Joint Surg Br 1999;81:667-9. |
|4||Albrecht S, Gutchfield JS, SeGall GK. On spinal osteochondromas. J Neurosurg 1992;77:247-52.|
|5||Silber JS, Mathur S, Ecker M. A solitary osteochondroma of the pediatric thoracic spine: A case report and review of literature. Am J Orthop 2000;29:711-4.|
|6||Gorospe L, Madrid-Muniz C, Royo A, Garcia-Raya P, Alvarez-Ruiz F, Lopez-Barea F. Radiation induced osteochondroma of the T4 vertebra causing spinal cord compression. Eur Radiol 2002;12:844-8.|
|7||Sharma MC, Arora R, Deol PS, Mahapatra AK, Mehta VS, Sarkar C. Osteochondroma of the spine: An enigmatic tumor of the spinal cord. A series of 10 cases. J Neurosurg Sci 2002;46:66-70.|
|8||Grivas TB, Polyzois VD, Xarchas K, Liapi G, Korres D. Seventh cervical body solitary osteochondroma: Report of a case and review of the literature. Eur Spine J 2005;14:795-8.|
|9||Spallone A, di Lorenzo N, Nardi P, Nolleti A. Spinal osteochondroma diagnosed by computer tomography. Report of two cases and review of literature. Acta Neurochir (Wien) 1981;58:105-14.|
|10||Gille O, Pointillart V, Vital JM. Course of spinal solitary osteochondromas. Spine 2005;30:E13-9.|