OSTEOCHONDROMA OF SPINOUS PROCESS IN CERVICAL SPINE

CASE REPORT
Saima Naqi, Muhammad Shafiq-ul-azam, Haji Haroon, Syed Mahmood, Shafqat Ul Islam, Sibtain Raza

Karachi X Rays & CT SCAN /Ultrasound Centre

INTRODUCTION DISCUSSION
 Osteochondromas are the most common benign bone
Osteochondromas accounts for approximately 20-50% of
tumor. These are cartilage covered bony excrescence
benign bone tumors and 10-15% of all bone tumors.
(exostosis) that arises from surface of a bone & the
Osteochondromas that represent the commonest of benign
cortex of the lesion is continuous with the cortex of bone,
bone tumors seldomly affect the spine. Spinal involvement is
with the homogenous continuation of medulla of host
seen in less than 2% of the cases1.
bone1. Most osteochondromas arise from the tubular
Pathologically, osteochondroma represent a dysplastic –
bones and are metaphyseal in location. The vertebral
hyperplastic disturbance of bone from progressive
localization of osteochondromas is seldom3,4,5. The true
enchondral ossification. Osteochondromas grow until skeletal
prevalence of solitary spinal osteochondroma is not
maturity. Growth generally stops once the growth plate
known, because many asymptomatic lesions go
fuses. Slow growth from the cap may continue over time, but
Figure 1 - X-ray C-spine Figure 2 - X-ray C-spine
undiagnosed. The painless skeletal swelling or a slowly
(lateral) showing bony (oblique) showing bony this usually stops by age 30 years.
growing mass is the usual mode of presentation, but they exostosis arising from exostosis arising from
Most are asymptomatic, but they can cause mechanical
spinous process of C3. spinous process of C3
can cause mechanical symptoms. Complications of
extending upto C4 level. symptoms depending on their location and size. Cervical
osteochondroma include fractures, bony deformities,
osteochondromas may compress the vertebral, subclavian
neurological and vascular injuries, malignant
and common carotid artery. It can also cause cord
transformation.
compression or nerve root compression. In our case there
were no neurological symptoms.
CASE REPORT The main method for diagnosis is X-ray and CT. Plain
radiography is the mainstay of imaging for
A 47 year old housewife was referred to our institute with osteochondromas. Good quality radiographs should be
a non tender firm swelling in midline on posterior aspect obtained in two perpendicular planes to characterize the
of neck at level of C3 and C4 vertebrae. On examination lesion fully. Classic radiographic features include orientation
no neurological deficit was noted neither were there any of lesion away from the physis and medullary continuity .The
limitations of neck movements. cartilaginous and bone component of the tumor can be
Her X-ray cervical spine, Anteroposterior, Lateral and Figure 3 - CT scan Figure 4 - CT scan (axial) determined by CT and its relationship with the peripheral
(sagittal) showing bony showing continuity of
Oblique views were performed, which showed a large exostosis arising from cortex and medullary region and neural tissue can also be determined. CT
bony outgrowth involving the spinous process of C3 spinous process of C3 cavity. localization can be useful when planning resection16.MRI is
vertebra.
vertebra mainly and extending upto C4 level (figure1 & also helpful for demonstration of spinal cord or nerve root
2). Cortex of the lesion was seen merging with that of the compression. Skeletal scintigraphy is not useful in the
parent bone. No bony destruction was noted and the workup of osteochondromas or for pre-operative planning for
surrounding soft tissues also appeared normal. Moreover resection.
no fractures could be found on the radiographs. There Historically and currently, most osteochondromas are
was some calcification of the anterior longitudinal incidental findings and are treated solely with observation. If
ligament. Based on these findings a most probable they remain asymptomatic, they can be ignored. Lesions
diagnosis of Osteochondroma was suggested. For that create mechanical symptoms become painful, begin to
confirmation of the diagnosis made on radiographs a CT enlarge, or cause growth disturbances, have been treated
scan was advised. with surgical removal and this remains the mainstay of
Figure 5- CT scan (3 D volume
CT scan of Cervical-Spine was performed on a 16 row rednered images) showing treatment.
bony exostosis arising from In conclusion cervical spinal osteochondromas are
multidetector CT scanner. Multiplanar reformations with
spinous process of C3
3D reconstruction images were obtained. CT showed a vertebra. uncommon and mostly found incidentally. The knowledge of
large bony exostosis arising from spinous process of C3 this condition however is essential since such tumors can
vertebra extending to spinous process of C4 vertebra occasionally cause neurological symptoms in which cases
with little fragmentation (figure 3, 4 & 5). Normal neural resection becomes essential.