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Year : 2001  |  Volume : 49  |  Issue : 1  |  Page : 100-1

Osteochondroma of the axis : letter to editor.






How to cite this article:
Sridhar K, Ramamurthi B. Osteochondroma of the axis : letter to editor. Neurol India 2001;49:100


How to cite this URL:
Sridhar K, Ramamurthi B. Osteochondroma of the axis : letter to editor. Neurol India [serial online] 2001 [cited 2023 Mar 30];49:100. Available from: https://www.neurologyindia.com/text.asp?2001/49/1/100/1287



A 4 year old boy presented with a palpable mass in the
paraspinal region of the neck, which was noticed by
his parents two months prior to presentation to us. He
complained of occasional pain in the region not
related to any specific activity or movement of the
spine. There were no symptoms or signs referable to
the limbs. There was no neurological deficit on
examination. A firm rounded non tender mass was
palable in the paraspinal region. The overlying skin
was normal. The lesion was not mobile. X-ray of the
spine showed a cauliflower like enlargment of the C2
spinous process [Figure:1]. CT scan of the cervical spine
showed a bony lesion arising from the spinous process
and lamina of C2 which had a superficial hypodense
'cap' [Figure:2]. The lesion was approached though a
posterior mildline incision. It was attached to the
posterior elements of C2 on the right side and was
firm and multilobulated. The spinous process itself
was bulbous and deformed. The lesion extended to the
pedicle on the right side. The soft tissue and bony
lesion were radically removed. Care was taken to
preserve the C2,3 joint, in order or prevent later
instability. Histopatholgical examination confirmed
the lesion to be an osteochondroma.
Osteochondromas are among the most frequent of
benign tumours of bone. They occur either as solitary
lesions or as multiple osteochondromatosis.[1],[2],[3]
However, the spine is affected in only 5 to 7% of these
tumours. Osteochondromas are commonly seen in the
second or the third decade of life. They develop from
progressive enchondral ossification and thus show
rapid growth. Spinal osteochondromas most
commonly affect the posterior elements of the spine,
though occasionally, they may invlove the pedicle and
other parts of the vertebral body. In 1977, Inglis et al1
reported the second case of osteochondroma affecting
the posterior elements of the cervical spine, and
suggested that it be considered in the differential
diagnosis of bony lesions affecting the spinal column.
The lesions present as asymptomatic palpable masses
or more unusually, with neurological deficit.[2]
Tumours of the axis may also present with nuchal
pain, or, as a parapharyngeal mass.4 X-rays are often
diagnostic as they clearly show the bony cum soft
tissue lesion. CT scans clearly delineate the origin of
the tumour and are useful in the diagnosis, and follow
up of these lesions, especially in the detection of early
recurrences. MRI demonstrates the relationship of the
tumour, the spinal cord, and adjacent soft tissue to
each other. However, diagnosis by MRI may be made
difficult due to unusual gadolinium enhancement by
the tumour.[5] Radical excision of the lesion is the
treatment of choice. This can sometimes be difficult,
due to the extent of the tumour and involvement of the
articular surfaces. The bulbous enlargement of the
bony structures distorts the normal anatomical
relationship in the region, and this should be kept in
mind during excision of these benign tumours. Our
patient was a young child who presented with an
enlarging palpable mass at the back of the neck.
Unusual features about the case were the young age of
presentation and the location of the solitary
osteochondroma.

 

  »   References Top

1.Inglis AE, Rubin RM, Lewis RJ et al : Osteochondroma of the cervical spine : case report. Clin Orthop 1977; 126 : 127-129.  Back to cited text no. 1    
2.Linkowski GD, Tsai FY, Recher L et al : Solitary osteochondroma with spinal cord compression. Surg Neurol 1985; 23 : 388-390.  Back to cited text no. 2    
3.O'Connor GA, Roberts TS : Spinal cord compression by an osteochondroma in a patient with multiple osteochondromatosis : case report. J Neurosurg 1984; 60 : 420-423.  Back to cited text no. 3    
4.Karnicki C : Osteochondroma of the axis bulging into the peripharyngeal space and pharynx. Otolaryngology (Poland) 1988; 42 : 375-377.  Back to cited text no. 4    
5.Morikawa M, Numaguchi Y, Soliman JA : Osteochondroma of the cervical spine. MR findings. Clin Imaging 1995; 19 : 275-278.  Back to cited text no. 5    

 

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