Vertebral osteochondroma

Case contributed by Dr Anil Rawat

Presentation

History of spastic paraparesis. A pre- and postcontrast MRI of the dorsal spine followed by non-contrast CT of cervico-dorsal spine were performed for further characterization of the lesion.

Patient Data

Age: 17 years
Gender: Female
MRI

A pedunculated bony outgrowth is seen arising from the right superior articular process of the T2 vertebra. This lesion shows a hypointense stalk on T2WIs, and the cap of the lesion shows T2 hyperintense signal. The lesion shows heterogeneous post-contrast enhancement and encroaches into the spinal canal and causing myelopathic changes of the underlying dorsal spinal cord. The lesion is also causing posterior scalloping of T2 vertebra due to pressure effect.

CT

A non-contrast CT of the cervical spine was also obtained, and the study reveals a solitary well-circumscribed bone tumor arising from the right superior articular process of the T2 vertebral body, with cortical continuity with the parent vertebra with associated central canal narrowing.

Case Discussion

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 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 osteochondromas 1.

When in the spine, osteochondromas most commonly arise from the cervical spine, with the C2 vertebra being the most 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 joints 3-5.
MRI is the investigation of choice for malignant transformation of osteochondroma, where the cartilaginous cap thickness can be directly evaluated. Bone scintigraphy can help in detection of additional osteochondromas 6. Asymptomatic osteochondromas don't require treatment; however, if symptomatic, they are excised at their base.

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Case information

rID: 45077
Published: 1st Jun 2016
Last edited: 21st Sep 2019
Inclusion in quiz mode: Excluded

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