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Kothari AR, Situt NV, Bhilare PD, Sancheti PK. O-arm Navigated en bloc Excision of a Solitary Subaxial Cervical Osteochondroma Presenting as Myelo-radiculopathy: A Case Report. J Orthop Case Rep 2023; 13:79-83. [PMID: 37398523 PMCID: PMC10308980 DOI: 10.13107/jocr.2023.v13.i06.3704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/15/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Vertebral osteochondroma is a rare entity. It presents with varied complaints ranging from palpable mass to myeloradiculopathy. En bloc excision is the gold standard treatment option for symptomatic patients. Real-time intraoperative navigation has increased the accuracy and safety of tumor excision. We report a case of cervical subaxial osteochondroma with myelo-radiculopathy, treated with excision, and monosegmental fusion under O-arm-based real-time navigation. Case Report A 32-year-old male presented with complaints of axial neck pain with the right upper limb radiculopathy for 18 months. On examination, signs of myelopathy were identified without sensory-motor deficit. Magnetic resonance imaging and computed tomography scans were suggestive of solitary C6 osteochondroma compressing spinalcord. O-arm navigated en-bloc tumor excision with C5 hemilaminectomy and monosegmental fusion was done. Conclusion The use of O-arm navigation aids in accurate intraoperative en bloc excision without any residual tumor and with better safety.
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Affiliation(s)
- Ajay R Kothari
- Department of Spine Surgery, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Nishad V Situt
- Department of Spine Surgery, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Pramod D Bhilare
- Department of Spine Surgery, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Parag K Sancheti
- Department of Knee Surgery, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India
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Lin GX, Wu HJ, Chen CM, Rui G, Hu BS. Osteochondroma Arising From the Inferior Articular Process of the Lumbar Spine in a Geriatric Patient: A Case Report and Literature Review. Geriatr Orthop Surg Rehabil 2022; 13:21514593211073028. [PMID: 35096462 PMCID: PMC8793394 DOI: 10.1177/21514593211073028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Spinal osteochondromas are rare, and approximately less than 5% occur as spinal lesions. We report the case of a solitary osteochondroma of the spine and review and update the literature on spinal osteochondroma, including surgical treatment and subsequent results. Case Description A 73-year-old female patient complained of a 10-year history of back pain and a 4-year history of right-side lower extremity radiating pain with paresthesia. Computed tomography and magnetic resonance imaging (MRI) revealed a bony mass arising from the inferior articular process (IAP) of L3, presenting with features of compressive spinal stenosis at the L3–L4 level. The treatment strategy included the complete marginal excision of the lesion through the posterior approach, as well as complete decompression of the spinal canal and nerve roots. The patient’s symptoms resolved after surgery, and histopathological examination identified the lesion as an osteochondroma. Review Results This review study included 168 solitary osteochondroma cases. The most commonly involved spinal level was cervical (51.8%), and the most frequent spinal anatomic column involved was the posterior column (70.8%). Radiculopathy accounted for 30.3% of all cases, myelopathy accounted for 31.0%, and 7.7% exhibited both symptoms simultaneously. The recurrence rate was 6.0%. Conclusion Computed tomography and MRI can effectively diagnose spinal osteochondroma, and surgical treatment can effectively improve clinical outcomes. In almost all symptomatic cases, the best treatment is marginal excision of the tumor. Complete resection of the cartilaginous cap of the tumor is especially important to prevent recurrence.
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Affiliation(s)
- Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Hua-Jian Wu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Gang Rui
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Bao-Shan Hu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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Suwak P, Barnett SA, Song BM, Heffernan MJ. Atypical osteochondroma of the lumbar spine associated with suprasellar pineal germinoma: A case report. World J Orthop 2021; 12:720-726. [PMID: 34631455 PMCID: PMC8472447 DOI: 10.5312/wjo.v12.i9.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/19/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Osteochondromas are the most common benign bone tumor, accounting for 36% of benign bone tumors. Often found within the appendicular skeleton, osteochondromas of the spine are rare, comprising 4% to 7% of primary benign spinal tumors.
CASE SUMMARY We report a case of a solitary lumbar osteochondroma in an 18-year-old male with a history of a suprasellar pineal germinoma treated with combined chemotherapy and radiation. He underwent mass excision and partial laminectomy with the ultrasonic bone scalpel (Misonix, Farmingdale, NY, United States) at the L5 Level without the use of adjuvants. The patient returned to work and full activities without back pain at 3 mo postoperatively.
CONCLUSION Osteochondromas are common tumors of the appendicular skeleton but rarely occur within the spine. This case discussion supplements current osteochondroma literature by describing an unusual presentation of this tumor.
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Affiliation(s)
- Patrik Suwak
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
| | - Scott A Barnett
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
| | - Bryant M Song
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
| | - Michael J Heffernan
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
- Department of Orthopaedic Surgery, Children's Hospital New Orleans, New Orleans, LA 70118, United States
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Pawar E, Gavhale S, Bansal S, Dave H, Yadav AK, Akshay KS. Solitary Osteochondroma of Posterior Elements of the Spine: A Rare Case Report. J Orthop Case Rep 2020; 10:1-5. [PMID: 33708699 PMCID: PMC7933648 DOI: 10.13107/jocr.2020.v10.i08.1832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Osteochondromas are the most common benign tumors of the bone accounting for 35% to 40% of all benign bone tumors. They present in two distinct clinical forms - solitary osteochondroma and multiple osteochondromas. Solitary osteochondroma accounts for 85% of all osteochondroma and is commonly seen in childhood and adolescence. They more frequently affect the appendicular skeleton and are rarely found in spine. Biopsy and imaging help in diagnosis and en bloc resection is the treatment of choice in symptomatic patients. CASE REPORT We present a case of a 6-year-old girl who presented with swelling over back for 4 years. Radiological evaluation and biopsy were done and the patient was diagnosed with osteochondroma of the left lamina and spinous process of dorsal 12th vertebral body which was managed with extraperiosteal en bloc excision. CONCLUSION Osteochondroma of the lamina and spinous process of vertebrae is rare and can be effectively treated by extraperiosteal en bloc resection and has a good post-operative outcome.
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Affiliation(s)
- Eknath Pawar
- Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai. Maharashtra. India
| | - Sandeep Gavhale
- Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai. Maharashtra. India
| | - Sagar Bansal
- Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai. Maharashtra. India,Address of Correspondence: Dr. Sagar Bansal, Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai. Maharashtra. India. E-mail:
| | - Harshit Dave
- Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai. Maharashtra. India
| | - Amit Kumar Yadav
- Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai. Maharashtra. India
| | - K S Akshay
- Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai. Maharashtra. India
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Transpedicular Excision of a Thoracic Intraspinal Osteochondroma in a Patient with Hereditary Multiple Exostoses and Brown-Séquard Syndrome. World Neurosurg 2017; 111:94-98. [PMID: 29258931 DOI: 10.1016/j.wneu.2017.12.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/08/2017] [Accepted: 12/09/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Spinal osteochondroma is a rare but recognized cause of myelopathy. Brown-Séquard syndrome is a form of severe myelopathy characterized by a clinical picture of hemisection of the spinal cord. Brown-Séquard syndrome caused by osteochondroma is extremely rare, calling for individualized surgical procedures. CASE DESCRIPTION We report a 16-year-old girl with hereditary multiple exostoses and a rare case of thoracic osteochondroma causing partial Brown-Séquard syndrome. Customized surgical procedures were designed to avoid iatrogenic spinal cord injury. The patient underwent neural decompression and tumor excision through a transpedicular approach. The surgical procedure consisted of 4 consecutive steps: 1) laminectomy, 2) costotransversectomy and pediculectomy, 3) extracavitary removal of the mass, and 4) pedicular fixation with fusion. Total resection of the tumor was achieved macroscopically without intraoperative spinal cord injury. The postoperative recovery was uneventful, and the patient returned to a normal life without evidence of recurrence at 24-month follow-up. CONCLUSIONS For patients with hereditary multiple exostosis and new onset of neurologic symptoms, the possibility of a spinal osteochondroma should be considered. In the situation of an intraspinal exostosis protruding from the lateral side, customized surgical procedures with a transpedicular approach may be a valid way to minimize intraoperative neural injury and achieve a satisfactory outcome.
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Sainte S, Decaluwé H, Vanbrabant P. Spontaneous Hemothorax, A Rare Face of Vertebral Osteochondroma. J Emerg Med 2017; 52:e225-e228. [PMID: 28268121 DOI: 10.1016/j.jemermed.2017.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/08/2017] [Accepted: 01/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Osteochondroma is the most common benign tumor of the bone. It is usually asymptomatic, but complications may result from mechanical injury to adjacent anatomic structures, such as the diaphragm and lung, when located intrathoracically. CASE REPORT We report the unusual occurrence of a large hemothorax and lacerated right diaphragm in a 41-year-old woman caused by vertebral osteochondroma affecting the eleventh thoracic vertebra. Thoracoscopic exploration with resection of the osteochondroma and repair of the diaphragm was performed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Spontaneous hemothorax is a potential life-threatening condition when the initial diagnosis is postponed and hemodynamic instability and hypovolemic shock occurs. Osteochondroma as a cause of spontaneous hemothorax is uncommon but may require urgent surgical intervention with video-assisted thoracoscopic surgery of thoracotomy to control the hemorrhage and prevent recurrence.
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Affiliation(s)
- Sarah Sainte
- Department of Emergency Medicine, University Hospital Leuven, Leuven, Belgium
| | - Herbert Decaluwé
- Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
| | - Peter Vanbrabant
- Department of Emergency Medicine, University Hospital Leuven, Leuven, Belgium; Department of Internal Medicine, University Hospital Leuven, Leuven, Belgium
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Veeravagu A, Li A, Shuer LM, Desai AM. Cervical Osteochondroma Causing Myelopathy in Adults: Management Considerations and Literature Review. World Neurosurg 2017; 97:752.e5-752.e13. [DOI: 10.1016/j.wneu.2016.10.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/08/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
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