Cervical osteochondroma with postoperative recurrence: case report and review of the literature

Tubbs, R. Shane; Maddox, Grady; Grabb, Paul A.; Oakes, W. Jerry; Cohen-Gadol, Aaron

doi:10.1007/s00381-009-0934-3

Cited by 15 publications

(17 citation statements)

References 24 publications

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“…Most osteochondromas arise in the appendicular skeleton and occur as solitary or multiple exostosis. 35,38,65 The latter is part of an inherited, autosomal dominant condition called hereditary multiple exostosis. 65 These lesions arise from epiphyseal herniation with a displaced portion of cartilage and hence the cartilaginous cap.…”

Section: Primary Bone Tumors Affecting the Atlantoaxial Skeleton Of Cmentioning

confidence: 99%

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Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Menezes¹,

Ahmed²

2014

PED

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Object Atlantoaxial tumors account for a substantial proportion of primary bone tumors in children. Before resection, surgeons must consider the complex regional anatomy, the potential for neurological compromise, craniocervical instability, and the question of tumor resectability in a growing spine. Using current technology, the authors analyzed surgical cases in this light and present outcomes and treatment recommendations after long-term patient follow-up. Methods: The authors reviewed clinical records for 23 children whose primary atlantoaxial bone tumors were treated from 1996 through 2010. Results Pathological lesions among the 23 patients were 4 aneurysmal bone cysts, 2 osteochondromas, 5 chordomas, 4 osteoblastomas, 3 fibrous dysplasias, 4 eosinophilic granulomas, and 1 Ewing's sarcoma. Clinical presentation consisted of neck pain (n = 23), headaches and occipital pain (n = 16), myelopathy (n = 8), and torticollis (n = 4). Selective angiography and coil embolization were undertaken for all patients with aneurysmal bone cysts and osteoblastomas, 2 patients with chordomas, 1 patient with fibrous dysplasia, and 1 patient with Ewing's sarcoma. Primary embolization treatment of radiation-induced aneurysmal bone cyst of the atlas showed complete reossification. Results of CT-guided needle biopsy were diagnostic for 1 patient with eosinophilic granuloma and 1 with Ewing's sarcoma. Needle biopsies performed before referral were associated with extreme blood loss for 1 patient and misdiagnosis for 2 patients. Surgery involved lateral extrapharyngeal, transoral, posterior, and posterolateral approaches with vertebral artery rerouting. Complete resection was possible for 9 patients (2 with osteochondroma, 3 with fibrous dysplasia, 2 with chordoma, and 2 with osteoblastoma). Decompression and internal fusion were performed for 3 patients with aneurysmal bone cysts. Of the 23 patients, 7 underwent dorsal fusion and 4 underwent ventral fusion of the axis body. Chemotherapy was necessary for the patients with eosinophilic granuloma with multifocal disease and for the patient with Ewing's sarcoma. There was no morbidity, and there were no deaths. All patients with benign lesions were free of disease at the time of the follow-up visit (mean ± SD follow-up 8.8 ± 1.1 years; range 2–18 years). Chordomas received proton or LINAC irradiation, and as of 4–15 years of follow-up, no recurrence has been noted. Conclusions Because most atlantoaxial tumors in children are benign, an intralesional procedure could suffice. Vascular control and staged resection are critical. Ventral transoral fusion or lateral extrapharyngeal fusion has been successful. Resection with ventral fusion and reconstruction are essential for vertebral body collapse. Management of eosinophilic granulomas must be individualized and might require diagnosis through needle biopsy.

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Section: Primary Bone Tumors Affecting the Atlantoaxial Skeleton Of Cmentioning

confidence: 99%

“…13,39,51,59,60,64 Tubbs et al reported on a rare case of recurrent osteochondroma after incomplete resection. 65 Our literature review indicated that all patients with multiple hereditary exostosis should undergo MRI of the spine because 27% will have spinal lesions.…”

Section: Primary Bone Tumors Affecting the Atlantoaxial Skeleton Of Cmentioning

confidence: 99%

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Menezes¹,

Ahmed²

2014

PED

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“…16 Some argue that osteochondromas are not true neoplasms but rather hamartomas herniating from the epiphyseal growth cartilage before children reach skeletal maturity. 2,13,23,29 These lesions are not usually identified until adulthood, with a mean age of 39 years at diagnosis. 26 Given that these exophytic growths arise from the posterior elements of the spine, osteochondromas are commonly managed with posterior resection.…”

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confidence: 99%

Long-term outcomes in primary spinal osteochondroma: a multicenter study of 27 patients

Sciubba

Macki

Bydon

et al. 2015

SPI

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OBJECT Clinical outcomes in patients with primary spinal osteochondromas are limited to small series and sporadic case reports. The authors present data on the first long-term investigation of spinal osteochondroma cases. METHODS An international, multicenter ambispective study on primary spinal osteochondroma was performed. Patients were included if they were diagnosed with an osteochondroma of the spine and received surgical treatment between October 1996 and June 2012 with at least 1 follow-up. Perioperative prognostic variables, including patient age, tumor size, spinal level, and resection, were analyzed in reference to long-term local recurrence and survival. Tumor resections were compared using Enneking appropriate (EA) or Enneking inappropriate surgical margins. RESULTS Osteochondromas were diagnosed in 27 patients at an average age of 37 years. Twenty-two lesions were found in the mobile spine (cervical, thoracic, or lumbar) and 5 in the fixed spine (sacrum). Twenty-three cases (88%) were benign tumors (Enneking tumor Stages 1–3), whereas 3 (12%) exhibited malignant changes (Enneking tumor Stages IA–IIB). Sixteen patients (62%) underwent en bloc treatment—that is, wide or marginal resection—and 10 (38%) underwent intralesional resection. Twenty-four operations (92%) followed EA margins. No one received adjuvant therapy. Two patients (8%) experienced recurrences: one in the fixed spine and one in the mobile spine. Both recurrences occurred in latent Stage 1 tumors following en bloc resection. No osteochondroma-related deaths were observed. CONCLUSIONS In the present study, most patients underwent en bloc resection and were treated as EA cases. Both recurrences occurred in the Stage 1 tumor cohort. Therefore, although benign in character, osteochondromas still require careful management and thorough follow-up.

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“…2 Only 1% to 4% of cases involve the spine, of which half involve the cervical spine, making cervical spine osteochondroma a rare entity. [3][4][5] Two cases of solitary osteochondroma arising from the anterior aspect of the vertebral bodies of C2 and C7 have been reported 4,6 ; however, none have been reported for C4. We report the first case of solitary osteochondroma arising from the anterior body of C4.…”

mentioning

confidence: 99%

Cervical Spine Osteochondroma: Rare Presentation of a Common Lesion

Reckelhoff

Green²,

Kettner

2010

Journal of Manipulative and Physiological Therapeutics

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Cervical osteochondroma with postoperative recurrence: case report and review of the literature

Cited by 15 publications

References 24 publications

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Long-term outcomes in primary spinal osteochondroma: a multicenter study of 27 patients

Cervical Spine Osteochondroma: Rare Presentation of a Common Lesion

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