Spinal cord compression due to C4 vertebral arch osteochondroma

Abstract

Osteochondromas are usually benign bone tumors found on the metaphysis of long bones. These tumors are rarely located on the spine especially at cervical level. This report presents the case of a 23-year-old man who had previously developed tetraparesis at the age of 13 after infectious myelitis. Recent severe clinical neurological deterioration revealed the diagnosis of osteochondroma arising in the C4 vertebral arch compressing the spinal cord and associated with syringomyelia. Of note in his past history was a treated hip localization. The patient underwent complete surgical excision of the osteochondroma. Postoperative outcome was good with slow clinical recovery from the spinal cord compression. We report this rare cause of spinal cord compression and other cases reported in the literature.

Solitary Osteochondroma Arising from Cervical Spina Bifida Occulta

“…The most common symptoms are radiating pain, motor deficits, sensory disturbances, and urinary incontinence [3]. The clinical signs and symptoms appear in second and third decades of life, with an average age of 20 at the time of diagnosis [13, 14]. In our case, the solitary osteochondroma arose from the right posterior element of C5 vertebra and from the bifid lamina, and it caused compressive radicular symptoms in the right upper extremity.…”

“…All levels of vertebral column can be involved, but the site most affected by isolated osteochondromas is C1 and for the multiple forms C2 [12, 13]. Spinal osteochondromas usually arise from the posterior elements that are the secondary ossification centers, and most commonly near the tips of the spinous processes [10].…”

“…The symptoms occur when the tumor compresses the spinal cord, nerve roots, or surrounding structures [3]. Spinal cord compression is more frequent in the familial forms than in the solitary forms [2, 13]. The most common symptoms are radiating pain, motor deficits, sensory disturbances, and urinary incontinence [3].…”

“…The detection of spinal osteochondromas is difficult on plain radiographs because of the complex image formed by the spinal bony elements [10, 13]. CT is the choice for diagnosis due to its convenience in revealing the cartilaginous and osseous structures of the lesion [3, 10, 13].…”

“…CT is the choice for diagnosis due to its convenience in revealing the cartilaginous and osseous structures of the lesion [3, 10, 13]. MRI is more useful than CT to define the relationship between tumor and the neighboring structures like dural sheath and it also shows the spinal cord compression [10, 13]. The main complication of osteochondroma is malignant transformation, not the local spinal cord compression.…”