Outcome and prognosis of myelopathy and radiculopathy from osteochondroma in the mobile spine: a report on 14 patients.

STUDY DESIGN

A retrospective study of 14 spinal osteochondroma (OC) patients with compressive myelopathy or radiculopathy who underwent excision of the lesions.

OBJECTIVE

To evaluate the surgical results of a series of cases of symptomatic OCs and the risk of recurrence and malignant transformation in the mobile spine.

SUMMARY OF BACKGROUND DATA

Intraspinal OC with symptomatic spinal cord or nerve root compression is a rare disease. Most of the lesions require surgical treatment. However, some patients may relapse or malignant transformation may occur after surgery.

METHODS

Fourteen symptomatic spinal OC cases, including 2 hereditary multiple exostoses, were treated surgically from 2001 to 2010. The clinical history, plain radiographs, computed tomography, magnetic resonance imaging, pathologic characteristics, surgical treatments, and outcomes were reviewed. All the patients were followed up for an average of 48.9 months.

RESULTS

The 14 patients included 8 with lesions in the cervical spine, 3 with lesions in the thoracic spine, and 2 with lesions in the lumbar spine. One patient had a particularly large lesion which extended from C7 to T6. The OCs originated from the lamina (4), lateral mass (3), vertebral body (3), processus transversus (1), spinous process (1), pedicle of vertebral arch (1), and an indeterminate location (1). Six patients presented with myelopathy from spinal cord compression and 8 with radiculopathy from nerve root compression. Operative approaches included posterior (11) and combined posterior anterior (3) patients. The surgical outcome was satisfactory in 79% (11) of patients. Two recurrent lesions were notable for sarcomatous transformation.

CONCLUSIONS

We recommend gross total resection of all diagnosed OCs involving the mobile spine because of the risk of malignant transformation. Early detection and total excision of symptomatic spinal lesions in these cases may be the key to providing the best outcome. The neurological defect arising from OC can be improved by surgical intervention in most patients.