Osteochondromas are the most commonly found benign neoplasms of bone, typically affecting long bones, most frequently the distal femur and proximal tibia. The lesion has core and cap that contains both cortical and medullary bone and a hyaline cartilage respectively. Multiple osteochondromas are associated with hereditary multiple exostoses.
Bony deformity, fracture, vascular compromise, neurologic sequelae, bursa formation, and malignant degeneration are complications of osteochondromas1.
When in the spine, osteochondromas most commonly arise from the cervical spine, with the C2 vertebra being the ost commonly involved segment 2. Within the spine, they most commonly arise from spinous and transverse processes, but can also arise from the vertebral body, pedicle, and rarely the facet joints3,4,5.
MRI is the investigation of choice for malignant transformation of osteochondroma, where the cartilagenous cap thickness can be directly evaluated. Bone scintigraphy can help in detection of additional osteochondromas6. Asymptomatic osteochondromas don't require treatment; however, if symptomatic, they are excised at their base.