Neurological manifestations, imaging characteristics, and surgical outcome of intraspinal osteochondroma

Clinical article

Iraj Lotfinia M.D.1, Payman Vahedi M.D.2, R. Shane Tubbs M.S., P.A.-C., Ph.D.3, Mostafa Ghavame M.D.4, and Ali Meshkini M.D.2
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  • 1 Departments of Neurosurgery and
  • | 4 Radiology, Shohada Hospital, and
  • | 2 Neurosurgery, Imam Hospital, Tabriz University of Medical Sciences, Tabriz, Iran; and
  • | 3 Department of Pediatric Neurosurgery, University of Alabama Birmingham, Alabama
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Object

Spinal osteochondromas (OCs) are rare and can originate as solitary lesions or in the context of hereditary multiple exostoses. Concurrent spinal cord compression is a very rare entity. The purpose of this study was to evaluate the authors' 10-year experience with the imaging characteristics and surgical outcome in patients with symptomatic spinal OC.

Methods

Between 1997 and 2007, 8 consecutive cases of symptomatic intraspinal OC with documented spinal cord compression were treated surgically. These patients were analyzed with regard to presentation, imaging, and outcome. The relevant English literature was reviewed using MEDLINE and Google search engines.

Results

Three patients had cervical, 2 had thoracic, and 3 had lumbar lesions. Classic MR imaging characteristics were rarely found. Multiple hereditary exostoses were equally responsible for cervical, thoracic, and lumbar lesions (33%). The origin of the lesion was from the pedicle (25%), lamina (25%), vertebral body (25%), and superior or inferior facets (25%). A posterior approach to the spine was used in 6 patients, and a combined anterior and posterior approach with fusion was performed for 2 thoracic lesions. Surgical outcome was satisfactory in 75% of patients. The prognosis was poor in the patients with thoracic lesions.

Conclusions

In the authors' experience, early detection and surgical removal in cases of symptomatic spinal OC is a key element for the best outcome. Posterior approaches are generally sufficient. The chronicity of symptoms may limit functional recovery postoperatively, especially with cervical and thoracic lesions.

Abbreviations used in this paper:

DTPA = diethylenetriamine pentaacetic acid; HME = hereditary multiple exostoses; OC = osteochondroma; SOC = solitary OC; VB = vertebral body.

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Contributor Notes

Address correspondence to: Iraj Lotfinia, M.D., Department of Neurosurgery, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. email: iraj.lotfinia@yahoo.com.
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