Presentation
Hard swelling on central back for two years. Complain of pain and progressive increase in size for last 6 months.
Patient Data
Irregular osseous lesion along the spinous process of 1st lumbar vertebra. Spina bifida S1. No fracture, dislocation or paravertebral soft tissue abnormality is noted.
A well-defined outgrowth measuring approximately 2.2 x 3.6 cm is noted along the spinous process of L1 vertebra. The cortex and medullary cavity of this lesion appears to be in continuity with the cortex and medullary cavity of the spinous process of L1 vertebra. No bone destruction or soft tissue component seen associated with it. No intraspinal extension is seen. A small posterior osteophyte is noted at L2/L3 intervertebral disc level. Few schmorl nodes are also noted in the lumbar spine. Gross morphology of the lumbar spinal canal is within normal limits.
A well-defined outgrowth is noted along the spinous process of L1 vertebra. The cortex and medullary cavity of this lesion appear to be in continuity with the cortex and medullary cavity of the spinous process of L1 vertebra. It has a cartilaginous cap measuring 3 mm. Some bone marrow edema is noted at the tip of the spinous process. Mild edema is noted in the subcutaneous soft tissues of the lower lumbar spine.
Histopathology confirming the imaging findings of osteochondroma.
The bony outgrowth noted along the spinous process of L1 vertebra had been completely excised.
Case Discussion
Imaging findings are suggestive of L1 spinous process osteochondroma with normal cartilaginous cap and no signs of malignant transformation. Other possible differential is exostosis (no cartilage cap).
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