Department of Neurosurgery, Desert Regional Medical Center, 1150 North Indian Canyon Dr., Palm Springs, CA, 92262, USA.
Department of Neurosurgery, Riverside University Health Systems, 26520 Cactus Avenue, Moreno Valley, CA, 92555, USA.
Spinal Cord Ser Cases. 2020 May 28;6(1):44. doi: 10.1038/s41394-020-0292-7.
Osteochondromas are benign bone tumors which occur as solitary lesions or as part of the syndrome multiple hereditary exostoses. While most osteochondromas occur in the appendicular skeleton, they can also occur in the spine. Most lesions are asymptomatic however some may encroach on the spinal cord or the nerve roots causing neurological symptoms. While most patients with osteochondromas undergo laminectomy without fusion, laminectomy with fusion is indicated in appropriately selected cases of spinal decompression.
We present a case of a 32-year-old male with history of multiple hereditary exostoses who presented with symptoms of bilateral upper extremity numbness and complaints of gait imbalance and multiple falls. He reported rapid progression of his symptoms during the 10 days before presentation. Computed tomography of the cervical spine revealed a lobulated bony tumor along the inner margin of the cervical 4 lamina. He underwent cervical 3 and 4 laminectomies, partial cervical 2 and 5 laminectomies and cervical 3-5 mass screw placement. Pathology was consistent with osteochondroma. The patient's symptoms had markedly improved at follow-up.
According to our literature review, osteochondromas most commonly occur at cervical 2 and cervical 5. We present a case of an osteochondroma at a less common level, cervical 4. While most osteochondromas are addressed with laminectomy without arthrodesis, the decision of whether arthrodesis is necessary should be considered in all patients with osteochondroma as with any cervical decompression.
骨软骨瘤是良性骨肿瘤，可单发或作为多发性遗传性外生骨疣综合征的一部分。虽然大多数骨软骨瘤发生在附肢骨骼，但也可发生在脊柱。大多数病变无症状，但有些可能侵犯脊髓或神经根，导致神经症状。虽然大多数骨软骨瘤患者行单纯椎板切除术而无需融合，但在适当选择的情况下，脊柱减压需要行椎板切除术加融合。
我们报告了 1 例 32 岁男性，有多发性遗传性外生骨疣病史，表现为双侧上肢麻木，步态不稳和多次跌倒。他报告在就诊前 10 天症状迅速进展。颈椎 CT 显示颈椎 4 椎板内缘有一呈分叶状的骨性肿瘤。他接受了颈椎 3 和 4 椎板切除术、部分颈椎 2 和 5 椎板切除术以及颈椎 3-5 螺钉固定术。病理结果符合骨软骨瘤。随访时患者症状明显改善。
根据我们的文献复习，骨软骨瘤最常见于颈椎 2 和颈椎 5。我们报告了 1 例发生在较少见部位（颈椎 4）的骨软骨瘤。虽然大多数骨软骨瘤通过单纯椎板切除术而无需融合来治疗，但对于所有骨软骨瘤患者，都应考虑是否需要融合，就像任何颈椎减压一样。
