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OSOSTTEOCHON

EOCHONDDRROMOMAA OF

OF SPIN

SPINOOUUSS PRO

PROCECESSSS ININ CERV

CERVIICACALL SPSPIINNEE

CACASESE REP REPORORTT

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INTRODUCTION

Osteochondromas are the most common benign bone

tumor. These are cartilage covered bony excrescence

(exostosis) that arises from surface of a bone & the

cortex of the lesion is continuous with the cortex of bone,

with the homogenous continuation of medulla of host

bone 1 . Most osteochondromas arise from the tubular

bones and are metaphyseal in location. The vertebral

localization of osteochondromas is seldom 3,4,5 . The true

prevalence of solitary spinal osteochondroma is not

known, because many asymptomatic lesions go

undiagnosed. The painless skeletal swelling or a slowly

growing mass is the usual mode of presentation, but they

can cause mechanical symptoms. Complications of

osteochondroma include fractures, bony deformities,

neurological and vascular injuries, malignant

transformation .

CASE REPORT

A 47 year old housewife was referred to our institute with

a non tender firm swelling in midline on posterior aspect

of neck at level of C3 and C4 vertebrae. On examination

no neurological deficit was noted neither were there any

limitations of neck movements.

Her X-ray cervical spine, Anteroposterior, Lateral and

Oblique views were performed, which showed a large

bony outgrowth involving the spinous process of C3

vertebra mainly and extending upto C4 level (figure1 &

2). Cortex of the lesion was seen merging with that of the

parent bone. No bony destruction was noted and the

surrounding soft tissues also appeared normal. Moreover

no fractures could be found on the radiographs. There

was some calcification of the anterior longitudinal

ligament. Based on these findings a most probable

diagnosis of Osteochondroma was suggested. For

confirmation of the diagnosis made on radiographs a CT

scan was advised.

CT scan of Cervical-Spine was performed on a 16 row

multidetector CT scanner. Multiplanar reformations with

3D reconstruction images were obtained. CT showed a

large bony exostosis arising from spinous process of C3

vertebra extending to spinous process of C4 vertebra

with little fragmentation (figure 3, 4 & 5). Normal neural

OS OS T T EOCHON EOCHON D D R R OM OM A A OF OF

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OS OS T T EOCHON EOCHON D D R R OM OM A A OF OF

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bra.

DISCUSSION

Osteochondromas accounts for approximately 20-50% of

benign bone tumors and 10-15% of all bone tumors.

Osteochondromas that represent the commonest of benign

bone tumors seldomly affect the spine. Spinal involvement is

seen in less than 2% of the cases 1 .

Pathologically, osteochondroma represent a dysplastic –

hyperplastic disturbance of bone from progressive

enchondral ossification . Osteochondromas grow until skeletal

maturity. Growth generally stops once the growth plate

fuses. Slow growth from the cap may continue over time, but

this usually stops by age 30 years.

Most are asymptomatic, but they can cause mechanical

symptoms depending on their location and size. Cervical

osteochondromas may compress the vertebral, subclavian

and common carotid artery. It can also cause cord

compression or nerve root compression. In our case there

were no neurological symptoms.

The main method for diagnosis is X-ray and CT. Plain

radiography is the mainstay of imaging for

osteochondromas. Good quality radiographs should be

obtained in two perpendicular planes to characterize the

lesion fully. Classic radiographic features include orientation

of lesion away from the physis and medullary continuity .The

cartilaginous and bone component of the tumor can be

determined by CT and its relationship with the peripheral

region and neural tissue can also be determined . CT

localization can be useful when planning resection 16 .MRI is

also helpful for demonstration of spinal cord or nerve root

compression . Skeletal scintigraphy is not useful in the

workup of osteochondromas or for pre-operative planning for

resection .

Historically and currently, most osteochondromas are

incidental findings and are treated solely with observation. If

they remain asymptomatic, they can be ignored. Lesions

that create mechanical symptoms become painful, begin to

enlarge, or cause growth disturbances, have been treated

with surgical removal and this remains the mainstay of

treatment.

In conclusion cervical spinal osteochondromas are

uncommon and mostly found incidentally. The knowledge of

this condition however is essential since such tumors can

occasionally cause neurological symptoms in which cases

resection becomes essential.