Cervical Osteochondroma Causing Myelopathy in Adults: Management Considerations and Literature Review

• Published in: World neurosurgery Vol. 97; pp. 752.e5 - 752.e13
• Main Authors: Veeravagu, Anand, Li, Amy, Shuer, Lawrence M, Desai, Atman M
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2017
• Subjects: Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - surgery; Decompression, Surgical - methods; Evidence-Based Medicine; Female; Humans; Laminectomy - methods; Male; Myelopathy; Neurosurgery; Osteochondroma; Osteochondroma - complications; Osteochondroma - diagnostic imaging; Osteochondroma - surgery; Spinal cord; Spinal Cord Compression - diagnostic imaging; Spinal Cord Compression - etiology; Spinal Cord Compression - prevention & control; Spinal Neoplasms - diagnostic imaging; Spinal Neoplasms - etiology; Spinal Neoplasms - surgery; Treatment Outcome; Young Adult; Myelopathy; CT; Spinal cord; Computed tomography; Magnetic resonance imaging; MRI; Osteochondroma; Multiple hereditary exostoses; MHE
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.10.061

Background Osteochondromas are the most frequent benign bone tumors but only rarely occur along the spinal column and even more rarely induce symptoms from spinal cord compression. Case Descriptions We report 2 adult patients, both with a history of hereditary multiple exostoses, who presented with cervical myelopathy secondary to osteochondromas. The first patient is a 22-year-old man with numbness and weakness of his right upper limb and neck pain. Radiologic images showed a bony tumor arising from the C3 lamina with evidence of severe spinal cord compression. The second patient is a 20-year-old woman with weakness of her left upper and lower limbs and progressive numbness of the left hand, as well as neck and back pain. Radiologic images showed a bony tumor arising from the C4 lamina with evidence of significant spinal cord compression and cord signal abnormality. Both patients underwent surgical excision of the epidural mass and pathology confirmed a diagnosis of osteochondroma. Conclusions We discuss the role of surgical intervention, management, and postoperative follow-up in adult patients with cervical osteochondromas. Recommended management includes radiographic imaging and surgical intervention, particularly when evidence of spinal cord impingement occurs. Consistent postoperative follow-up is necessary to ensure appropriate recovery of neurologic function. Surgical management of cervical osteochondromas typically results in excellent and stable clinical outcomes with rare recurrence.