Sacral Foraminal Osteochondroma Causing Radiculopathy

Abstract

Osteochondromas are the most common benign tumor of bone. These tumors are composed of a histologically normal osseous projection and a cartilaginous cap. The lesion is commonly metaphyseal, likely arising from a physis. Clinically, osteochondromas usually present as a painless protrusion or bump. The most common age of presentation is between ten and twenty years of age. These tumors are rarely found in the spinal column1. Only 1% to 4% of primary osteochondromas occur in the spine2,3 and, of these, less than 0.5% originate in the sacrum4. We present a case of an anterior sacral osteochondroma that extended into the neural foramen and caused radiculopathy in a young athletic man. Although sacral osteochondromas have been previously reported, this case demonstrates the ability of these tumors to extend into and through the neural foramen, producing radiculopathy. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. ### Clinical History and Diagnosis An otherwise healthy twenty-year-old male recreational soccer player presented with the symptom of six months of right leg pain. The history was noteworthy for prior back pain from a mild lumbar disc herniation on the right at the L4-L5 level, diagnosed with magnetic resonance imaging (MRI), which had been managed conservatively. For the six months prior to presentation, he reported experiencing a tingling and stabbing pain in the right buttock, posterior thigh, calf, and lateral aspect of the foot. He also had new onset of a “pins-and-needles” sensation in the lateral aspect of the right foot. The symptoms worsened with activity and prolonged sitting on hard surfaces. The patient stopped playing soccer secondary to severe stabbing leg pain. He denied muscle weakness, saddle anesthesia, bowel or bladder incontinence, weight loss, or night pain. Initial treatment was with physical therapy, nonsteroidal …