上胸椎椎管内骨膜性软骨瘤致脊髓受压和脊髓病：一例报告

Khadka Rabi, Pachhai Prarthana, Gurung Ashim, Shrestha Dipendra Kumar, Shilpakar Sushil Krishna

Department of Neurosurgery, Tribhuvan University Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, PO Box 3579, Maharajgunj, Kathmandu, Nepal.

Int J Surg Case Rep. 2022 Apr;93:106964. doi: 10.1016/j.ijscr.2022.106964. Epub 2022 Mar 29.

INTRODUCTION

Chondromas are slow-growing cartilage-forming benign tumors, rarely occurring in the spine. Generally, most spinal chondromas are asymptomatic; however, with slow progressive growth, these lesions may enlarge and expand and cause compressive neurological symptoms, resulting in radiculopathy or more commonly myelopathy due to direct neural compression.

PRESENTATION OF CASE

A 15-year-old male adolescent presented to Emergency Department with history of fall (slippage) on concrete ground while playing three months back. On neurological examination, the motor power in bilateral upper limbs was 5/5 while it was 1/5 in both lower extremities. Some muscle wasting was noted in the lower limbs. The planter reflexes were upgoing; and the sensory loss was below T6 spinal level. CT scan of dorsolumbar spine demonstrated a well-defined high-density lesion in lateral aspect of spinal canal at T2-T3 vertebral level adjacent to left T2-T3 facet joint. MRI of dorsal spine revealed a 3 × 2 × 1 cm-sized, well-defined, non-enhancing T1 low to isointense and T2/STIR heterogeneous hyperintense lesion with osseous and cartilaginous components in the left lateral aspect of spinal canal at T1-T3 level, causing compression and contralateral displacement of spinal cord. The patient was then subjected to posterior laminectomy, complete excision, followed by laminoplasty using minicranial plates and screws. Histopathology of the mass showed bony trabeculae with hematopoietic elements and attached lobules of hyaline cartilage, chondroid matrix and lobules of mature chondrocyte and myxoid changes. Postoperatively his power was improved slightly and he was able to stand up with some assistance. On six-month follow up, patient showed significant neurological improvement. He was able to walk independently with minimal assistance. He was able to control bowel and bladder functions.

DISCUSSION

Chondromas occurring in the spine are rare, accounting for only about 3% of all chondromas. Spinal chondromas are commonly encountered in the thoracic spine as in our case.

CONCLUSION

Complete en bloc surgical excision is generally recommended as the treatment of choice for cases with local and/or neurological symptoms.

引言

软骨瘤是一种生长缓慢的形成软骨的良性肿瘤，很少发生于脊柱。一般来说，大多数脊柱软骨瘤无症状；然而，随着缓慢渐进性生长，这些病变可能会增大并扩展，导致压迫性神经症状，由于直接神经受压而导致神经根病或更常见的脊髓病。

病例介绍

一名15岁男性青少年三个月前玩耍时在水泥地面摔倒（滑倒），随后被送往急诊科。神经系统检查显示，双侧上肢肌力为5/5，而双下肢肌力为1/5。下肢有一些肌肉萎缩。跖反射亢进；感觉丧失平面在T6脊髓节段以下。胸腰椎CT扫描显示，在T2 - T3椎体水平椎管外侧、紧邻左侧T2 - T3小关节处有一个边界清晰的高密度病变。胸椎MRI显示，在T1 - T3水平椎管左侧有一个3×2×1cm大小、边界清晰、无强化的T1低信号至等信号、T2/短tau反转恢复序列不均匀高信号病变，含有骨和软骨成分，导致脊髓受压并向对侧移位。该患者随后接受了后路椎板切除术、完整切除，然后使用微型颅骨板和螺钉进行椎板成形术。肿物的组织病理学显示有含造血成分的骨小梁以及附着的透明软骨小叶、软骨样基质、成熟软骨细胞小叶和黏液样改变。术后其肌力稍有改善，在一些帮助下能够站立。在六个月的随访中，患者神经功能有显著改善。他能够在极少帮助下独立行走。他能够控制大小便功能。