Osteochondroma of the Femoral Neck: A Rare Cause of Sciatic Nerve Compression

Abstract

A 39-year-old man presented with weakness and a nonmobile mass in the buttock of 5 months' duration. Hip flexion was limited to 70 degrees. Strength was diminished for both ankle/foot plantar and dorsiflexion. Sensation was decreased on the plantar and dorsal foot. A pedunculated osseous mass measuring 6x4 cm on the posterior femoral neck was seen on plain radiographs and magnetic resonance imaging. Electromyography showed moderate sciatic neuropathy of the peroneal and tibial branches. The patient underwent excision of the tumor through a posterior approach. Due to the risk of weakening the neck, two 7.3-mm cannulated screws were passed percutaneously into the head with fluoroscopic guidance. The final pathological report indicated the tumor was an osteochondroma. At 22-month follow-up, he had full resolution of the neurologic findings. Postoperatively, the patient reported improvement in numbness and tingling in the leg but continued to have moderate buttock pain. Left hip flexion increased to 115 degrees at last follow-up.The importance of protecting the medial femoral circumflex artery during approaches to the hip is paramount. In this case, the tumor arose from the central aspect of the quadratus femoris, with the superior muscle protecting the medial femoral circumflex artery from harm. Although osteochondromas are a rare cause of mass effect, they should be considered in the differential diagnosis of sciatic nerve compression in this anatomical location.

Solitary osteochondroma of ischial ramus causing sciatic nerve compression

“…Two of them originated from the femoral neck and the rest of them originated from the iliac crest and spinal canal that compressed nerve roots, mimicking L3-L5-S1 radiculopathy. [9][10][11][12] To the best of our knowledge, the ischial ramus location that causes sciatica has not been reported either. In the series of Campanacci [2] 1117 cases were reported; and only three cases dealt with the ischial ramus, none of them connected with sciatica.…”

Imaging of benign complications of exostoses of the shoulder, pelvic girdles and appendicular skeleton

“…Cases of sciatic nerve compression due to exostosis on the posterior aspect of the femoral neck have been reported [33,34]. This sciatic nerve entrapment must be differentiated from disco-radicular impingement.…”

Peripheral nerve injuries due to osteochondromas: analysis of 20 cases and review of the literature

“…21 In the literature, only individual cases of peripheral nerve compression secondary to solitary osteochondromas are available. 2,[4][5][6][8][9][10][11][12][13][14][15][16][17][18][19][20][22][23][24][25][26][27][28][29][30][31][32][33][34][36][37][38][40][41][42][43][44][45][46][47] This case series is the largest series of peripheral nerve compressions due to solitary osteochondromas, and our aim in this retrospective study was to investigate the mechanisms, diagnostic …”