Acute cervical myelopathy from hereditary multiple exostoses: case report

Spinal Screening MRI Trends in Patients with Multiple Hereditary Exostoses: National Survey

Background

Multiple hereditary exostoses (MHE) is a rare disease characterized by multiple osteochondromas. Osteochondromas growing into the spinal canal can produce devastating consequences, including permanent neurologic deficits and even death. Routine screening of the entire spinal canal with magnetic resonance imaging (MRI) is a controversial topic lacking a clear consensus or recommendation to guide decision-making. This study presents a case of an intracanal osteochondroma at C1 identified by routine screening and a survey describing current practices of MHE experts.

Methods

MHE experts were surveyed. Survey questions addressed multiple aspects of care, including the type of practice center, the volume of patients with MHE, and current screening practices.

Results

A total of 104 experts were contacted, with a total of 26 experts participating in the survey and 23 completing the entire survey. Seventy-two percent of respondents do not perform a routine MRI screen of the spine. For experts that routinely screen, screening is performed across a wide/variable age range (4-18 years).

Conclusion

Screening protocols for MHE patients to identify osteochondromas within the spinal canal has struggled to reach consensus due to the rarity of the disease. Recent literature provides conflicting advice for patients without neurological symptoms. Our study demonstrates that even experts who are leading the field demonstrate wide practice variability. Most respondents do not routinely perform screening spinal MRI. Due to the wide variability, a national guideline is needed to help guide physician and parental decision-making for patients with MHE. Our case illustrates the potential benefit of identifying an osteochondroma within the spinal canal at a location where further growth could have devastating neurological sequelae.

Cervical myelopathy due to a solitary osteochondroma: a case report

Introduction

Osteochondroma is the most common benign bone tumor. However, the incidence of osteochondroma in the spine is reported to be very rare.

Case description

This report presents the case of a 57-year-old man who suffered from osteochondroma of the cervical spine. He had bilateral lower extremity pain for 3 years, developing pain of right upper extremity and gait disturbance. Plain radiographic images and computed tomography scans showed bony lesion in right C6/7 foramen and C6 lamina. Magnetic resonance images of whole spine showed severe compression of spinal cord at the C6/7 and spinal canal stenosis at the L3/4 level. First, we performed a surgery of the cervical spine, and removed the tumor covered with the cartilaginous cap. The pathological diagnosis of the tumor was osteochodroma. After the surgery, the symptoms on his right upper extremity improved smoothly. Because the bilateral lower extremity pain remained, a L3/4 partial laminectomy was performed 1 month later, and the symptom improved. At 1 year after his primary operation, we could not find a recurrence of the tumor.

Conclusions

It is very important to perform a complete en bloc resection of the tumor (especially cartilaginous cap) to prevent the recurrence.

Spinal stenosis frequent in children with multiple hereditary exostoses

PURPOSE

Children with multiple hereditary exostoses (MHE) have numerous osteochondromas, with the most prominent lesions typically over the appendicular skeleton. A recent report noted a high rate of intracanal lesions in this patient population and recommended preventative spinal screening with magnetic resonance imaging (MRI) or computed tomography (CT). We sought to evaluate the prevalence of spinal stenosis from intracanal osteochondromas at our pediatric orthopedic center in order to evaluate if routine screening is warranted.

METHODS

All pediatric patients treated for MHE were retrospectively identified. Records were reviewed to determine demographics, previous orthopedic surgery, and indication and results of axial spine imaging (CT or MRI). Imaging studies were reviewed to evaluate the presence of intracanal and compressive spinal lesions.

RESULTS

Between 1990 and 2011, axial imaging was performed in nine patients with MHE due to concerns of pain, weakness, and/or dizziness. These patients had moderate disease involvement, with a mean of 4.9 previous orthopedic surgeries to address skeletal osteochondromas. Two patients with MHE had cervical spinal stenosis secondary to intracanal osteochondromas. Both children successfully underwent spinal decompression. Thus, of our MHE population undergoing axial imaging, 22 % were noted to have intracanal lesions.

CONCLUSIONS

Our experience reveals a >20 % rate of compressive intracanal osteochondromas in MHE patients undergoing spinal imaging. These two patients represent 5 % of the MHE patients treated at our center. These lesions may be slow growing, and significant consequences can occur if not identified promptly. Thus, we confer that routine axial screening of the spinal canal may be warranted in these children.

Seventh cervical vertebral body solitary osteochondroma. Report of a case and review of the literature

Solitary osteochondroma of the cervical spine is a rare manifestation of a common bony tumour. It can create symptoms, depending on the adjacent compressed structures. In this report, a patient suffering solitary osteochondroma on the anterolateral aspect of the C7 vertebral body is presented and the literature is reviewed. A 46-year-old female presented with dysphagia and pain at the anterolateral surface of her neck during cervical movements or application of local pressure. The clinical and imaging assessment ascertained that the above complaints were due to a local tumour in the neck firmly attached to the spine at the anterolateral aspect of the C7 and which resembled an osteochondroma. Surgical treatment was chosen due to the persistence of the symptoms. The lump was resected using an anterolateral cervical approach and it was sent to the pathology department for confirmation of the lesion's histological character. The patient was completely relieved of her symptoms. Resection of the osteochondroma seems to be the only reliable solution for definitive relief from the clinical complaints. This surgical treatment, as it is reported, has no major complications and gives good functional results. One to four per cent of the osteochondromas are located at the spine. At the cervical spine, they can cause neurological symptoms and more rarely, dysphagia. Reviewing the literature, no case of solitary osteochondroma located in the anterior aspect of the C7 body was found. Two cases suffering from dysphagia were reported due to external compression by anterior hyperostosis of the cervical spine, but not due to osteochondroma.

Hereditary multiple exostosis with spinal cord compression in a 13-year-old boy

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