Spinal cord compression caused by multiple spinal osteochondromas

Abstract

Spinal cord compression caused by multiple spinal osteochondromasA 15-year-old boy with positive family history of osteochondromatosis presented with a three-month history of progressive paraparesis and a month history of urinary incontinence. The patient underwent irradiation of the whole neuroaxis for meduloblastoma at the age of 18 months. The CT and MRI showed multilevel osteochondromas of the spine with irregularly narrowed spinal canal to the level of complete obliteration, and spinal cord compression and displacement ( Fig. 1A and 1B). MRI delineated the extent of the osteochondromas, particularly the cartilage cap, more accurately than CT. MRI was also superior in visualizing spinal cord compression. CT, however, was performing better in analysis of the bony structures of the tumors, calcifications, and in assessment of the spinal canal deformity (Fig. 1C). After laminectomy and partial resection of the tumor masses, neurological deficits remained, despite achieved decompression of the neural structures. Postoperative CT and MRI of the spine revealed residual exostosis that caused displacement of the spinal cord and postischemic changes of the spinal cord at the level Th2 (Fig. 2). Histological analysis of the removed specimens confirmed the benign nature of the tumors. Osteochondroma is a cartilaginous tumor, the most common benign tumor of the bone. It may be solitary, or multiple (osteochondromatosis, usually with autosomal dominant inheritance) [1,2]. We believe that the osteochondromatosis in our patient was hereditary with possible acceleration of progression of the tumor growth caused by irradiation since it may be induced by radiation exposure [3].

Unusual case of hereditary multiple exostoses presenting with compressive myelopathy

“…Incidence of MHE involving multiple vertebral levels is uncommon with few cases reported 3 4. Compressive myelopathy is more commonly seen with solitary osteochondroma than in MHE 1 7.…”

“…Though there are reports of solitary osteochondroma causing spinal cord compression, involvement of the cord in patients with MHE is rare 3. MHE involving the spine at different levels is also not common 3 4. We report an unusual case of MHE with osteochondromas at D7, D11 and L5 vertebral levels presenting with compressive myelopathy.…”