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Osteochondroma of the C5 Lamina With Cord Compression: Case Report and Review of the Literature

Ratliff, John MD; Voorhies, Rand MD

Case Reports

Study Design. Case report of a solitary osteochondroma of the cervical spine causing myelopathy in a 66-year-old woman.

Objectives. To review the relevant literature and describe a highly unusual clinical manifestation of solitary osteochondroma.

Summary of Background Data. Osteochondromas are common benign bony lesions that seldom occur in the axial skeleton. These lesions are more commonly reported with neural compression in cases of hereditary multiple exostoses (Bessel-Hagel syndrome, diaphyseal aclasis).

Methods. Chart review, review of relevant radiographic examinations and histopathologic specimens, clinical follow-up with examination, and literature review.

Results. Manifestation with new neurologic deficit in a 66-year-old patient was singular.

Conclusions. Osteochondromas are unusual in the axial skeleton, and are rarely signaled by neural compression. Occurrence is generally in young adults in the second and third decades. Initial manifestation with a new neurologic deficit in a 66-year-old patient was highly unusual.

Osteochondromas are the most common benign tumors of the appendicular skeleton. 7 They occur less frequently in the axial skeleton, and association with compression of neural elements is even rarer. 7,11 In hereditary multiple exostosis (HME), multiple osteochondromas are found, with spinal involvement in roughly 3% of cases. 11,16 Any portion of the vertebral body may be affected.

Osteochondromas involving the spine may produce symptoms through compression of spinal roots or of the spinal cord itself or may remain asymptomatic. 18 Occurrence, especially in cases of HME, is generally in young adults, with most cases becoming symptomatic during the second and third decades of life. 10,12,15,16 Progression of symptoms is believed to relate to continued bone growth. 7

This is a report of an unusual case of isolated osteochondroma of the lamina of C5 signaled by myelopathy in the seventh decade. A brief review of the literature of this uncommon lesion is included. Of particular note in the current case is the advanced age of this patient, singular in the literature and quite unusual for a pathologic process that is usually first noted much earlier.

From the Department of Neurosurgery, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana.

Acknowledgment date: December 30, 1998.

First revision date: April 19, 1999.

Acceptance date: August 6, 1999.

Address correspondence to

Rand Voorhies, MD

Ochsner Clinic

1514 Jefferson Highway

New Orleans, LA 70121

E-mail: rvoorhies@ochsner.org

No reprints will be available.

Device status category: 1.

Conflict of interest category: 12.

© 2000 Lippincott Williams & Wilkins, Inc.