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Table of Contents    
LETTERS TO EDITOR
Year : 2018  |  Volume : 66  |  Issue : 2  |  Page : 555-556

Solitary facet joint osteochondroma of the upper thoracic spine: An unusual cause of cord compression in the pediatric age group


Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication15-Mar-2018

Correspondence Address:
Dr. Krishna Prabhu
Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.227328

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How to cite this article:
Ganesh S, Jonathan GE, Patel B, Prabhu K. Solitary facet joint osteochondroma of the upper thoracic spine: An unusual cause of cord compression in the pediatric age group. Neurol India 2018;66:555-6

How to cite this URL:
Ganesh S, Jonathan GE, Patel B, Prabhu K. Solitary facet joint osteochondroma of the upper thoracic spine: An unusual cause of cord compression in the pediatric age group. Neurol India [serial online] 2018 [cited 2019 Oct 15];66:555-6. Available from: http://www.neurologyindia.com/text.asp?2018/66/2/555/227328




Sir,

A 9-year old boy with normal birth and developmental history, presented with progressive spasticity of both lower limbs for 5 months. He had flexor spasms of both lower limbs and had been bed-bound for 3 months with bladder disturbances for 1 month. Examination revealed severe spasticity of both lower limbs with features of myelopathy. The sensory level was at T4. There were no palpable bony swellings seen on general examination. Imaging [magnetic resonance imaging (MRI) and computed tomography (CT) scan] showed a lobulated expansile bony lesion measuring 2 × 2 × 2 cm 3 arising from the facet joint and the pedicle of T4 vertebra. The lesion had a T2 hyperintense cartilagenous cap visible on thoracic MRI. It was extending into the spinal canal superiorly up to the T3 level on the left side, with scalloping of the posterior vertebral body causing cord compression and sharp T2 weighted changes in the spinal cord [Figure 1] and [Figure 2]. He underwent a T3-4 laminectomy and total excision with a T3-6 posterior stabilization [Figure 3]. There was significant improvement in the lower limb spasticity in the immediate postoperative period and he was ambulated on a wheel-chair at discharge. His biopsy was reported as an osteochondroma [Figure 4]. At a 6-month follow-up visit, he had improved his functionally to Nurick grade 3 and was independent for activities of daily living.
Figure 1: MRI thoracic spine sagittal (a) and axial (b) views, demonstrating a lobulated expansile lesion arising from the facet joint and the pedicle of T4 vertebra on the left side, extending into the spinal canal and causing cord compression. The pathognomonic cartilaginous cap is hyperintense on T2-weighted sequences

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Figure 2: Axial (a) and coronal CT (b) scans showing the relationship of the tumor to the pedicle and the facet joints

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Figure 3: Postoperative CT scan showing complete excision of the tumor with posterior stabilization

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Figure 4: Microscopic sections show the cartilaginous tumor composed of lobules of chondrocytes with a hyaline cap* (a: ×50; and b: ×100 magnification). The individual chondrocytes appear bland with no features of anaplasia or mitotic activity

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Osteochondromas are the most common benign tumors (seen in up to 40% case) of the long bones arising from the metaphysis and are believed to occur due to herniation of the fragments of epiphyseal growth plate through the periosteal bony cuff.[1],[2] Spinal osteochondromas are extremely rare lesions, arising predominantly from the posterior elements and are often encountered in the cervical spine, due to the increased mobility of this region and its propensity of being subjected to trivial trauma. These lesions are rarely seen in the thoracic spine.[3],[4] Facet joints involvement is a very unusual presentation of these lesions.[5] These tumors are composed of a stalk and body, made of mature osseous tissue with a cartilaginous cap that is in continuity with the cortex of the surrounding bone.[2] The classical cartilaginous cap never ossifies, and hence, is not visualized on plain roentgenograms. The cap is characteristically hyperintense on T1 and T2 weighted sequences and can easily be identified on a preoperative MRI.[1],[6] In addition, it is also important to assess the thickness of this cap as there is an increased risk of malignant transformation when the thickness exceeds 3 cm.[4] These lesions are usually benign and rarely recur following wide local excision; however, it is important to excise the cartilaginous cap to prevent recurrence.[5],[7] Involvement of the facet joint mandates a stabilization procedure in addition to performing a wide local excision and decompression.

A spinal osteochondroma is a rare cause of compressive myelopathy in the pediatric age group. These lesions can be reliably identified on the MRI by the T2 hyperintense cartilaginous cap. It is also worthwhile noting the thickness of the cap to determine the malignant potential of these otherwise benign lesions. Wide local excision with or without stabilization is often curative and recurrences are rare if the cartilaginous cap is completely excised.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Murphey MD, Choi JJ, Kransdorf MJ, Flemming DJ, Gannon FH. Imaging of osteochondroma: Variants and complications with radiologic-pathologic correlation. Radiographics 2000;20:1407-34.  Back to cited text no. 1
    
2.
Albrecht S, Crutchfield JS, SeGall GK. On spinal osteochondromas. J Neurosurg 1992;77:247-52.  Back to cited text no. 2
    
3.
Sharma MC, Arora R, Deol PS, Mahapatra AK, Mehta VS, Sarkar C. Osteochondroma of the spine: An enigmatic tumor of the spinal cord. A series of 10 cases. J Neurosurg Sci 2002;46:66-70.  Back to cited text no. 3
    
4.
Quirini GE, Meyer JR, Herman M, Russel EJ. Osteochondroma of the thoracic spine: An unusual cause of spinal cord compression. AJNR Am J Neuroradiol 1996;17:961-4.  Back to cited text no. 4
    
5.
Kulkarni AG, Goel A, Muzumdar D. Solitary osteochondroma arising from the thoracic facet joint—case report. Neurol Med Chir 2004;44:255-7.  Back to cited text no. 5
    
6.
Kitsoulis P, Galani V, Stefanaki K, Paraskevas G, Karatzias G, Agnantis NJ, et al. Osteochondromas: Review of the clinical, radiological and pathological features. In Vivo 2008;22:633-46.  Back to cited text no. 6
    
7.
Gille O, Pointillart V, Vital JM. Course of spinal solitary osteochondromas. Spine 2005;30:E13-9.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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