The solitary intraspinal vertebral osteochondroma. An unusual cause of compressive myelopathy: features and literature review.

Abstract

Reports of four patients with compressive myelopathy from solitary intraspinal vertebral osteochondromas. To evaluate the clinical presentation and radiographic findings of patients with intraspinal osteochondroma with compressive myelopathy and to review the relevant English-language medical literature. Involvement of the spine by solitary osteochondromas is rare. The addition of the current four cases to those already reported makes a total of 41 published cases of solitary vertebral osteochondromas with spinal cord compression. Clinical histories, computed tomographic studies, magnetic resonance imaging studies, routine radiographs, and/or myelographic studies of the lesions were reviewed. A review of the English-language medical literature also was done. Patients gradually improved or symptoms stopped progressing after surgical removal of the lesions. Although magnetic resonance imaging is the preferred method for localizing the lesion, computed tomography can be more specific, because of its sensitivity, when the diagnosis is in doubt. Osteochondromas represent a hyperplastic-dysplastic disturbance of bone from progressive endochondral ossification. The tumors slowly enlarge, creating insidious but progressive symptoms. Magnetic resonance imaging, computed tomography, and postmyelogram computed tomography are useful in evaluating the size and extent of spinal osteochondromas as a cause of spinal cord compression.