A rare case of solitary osteochondroma of the dens of the C2 vertebra

Chatzidakis, Emmanouel; Lypiridis, Savvas; Kazdaglis, G.; Chatzikonstadinou, K.; Papatheodorou, G.

doi:10.1007/s00701-007-1151-z

Cited by 27 publications

(22 citation statements)

References 6 publications

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“…62 Because up to 43% of spinal osteochondromas arise at the atlantoaxial level and 17% at C-7, they tend to occur at junctional-transitional areas. 13,39,51,59,60,64 Tubbs et al reported on a rare case of recurrent osteochondroma after incomplete resection. 65 Our literature review indicated that all patients with multiple hereditary exostosis should undergo MRI of the spine because 27% will have spinal lesions.…”

Section: Primary Bone Tumors Affecting the Atlantoaxial Skeleton Of Cmentioning

confidence: 99%

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Menezes¹,

Ahmed²

2014

PED

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Object Atlantoaxial tumors account for a substantial proportion of primary bone tumors in children. Before resection, surgeons must consider the complex regional anatomy, the potential for neurological compromise, craniocervical instability, and the question of tumor resectability in a growing spine. Using current technology, the authors analyzed surgical cases in this light and present outcomes and treatment recommendations after long-term patient follow-up. Methods: The authors reviewed clinical records for 23 children whose primary atlantoaxial bone tumors were treated from 1996 through 2010. Results Pathological lesions among the 23 patients were 4 aneurysmal bone cysts, 2 osteochondromas, 5 chordomas, 4 osteoblastomas, 3 fibrous dysplasias, 4 eosinophilic granulomas, and 1 Ewing's sarcoma. Clinical presentation consisted of neck pain (n = 23), headaches and occipital pain (n = 16), myelopathy (n = 8), and torticollis (n = 4). Selective angiography and coil embolization were undertaken for all patients with aneurysmal bone cysts and osteoblastomas, 2 patients with chordomas, 1 patient with fibrous dysplasia, and 1 patient with Ewing's sarcoma. Primary embolization treatment of radiation-induced aneurysmal bone cyst of the atlas showed complete reossification. Results of CT-guided needle biopsy were diagnostic for 1 patient with eosinophilic granuloma and 1 with Ewing's sarcoma. Needle biopsies performed before referral were associated with extreme blood loss for 1 patient and misdiagnosis for 2 patients. Surgery involved lateral extrapharyngeal, transoral, posterior, and posterolateral approaches with vertebral artery rerouting. Complete resection was possible for 9 patients (2 with osteochondroma, 3 with fibrous dysplasia, 2 with chordoma, and 2 with osteoblastoma). Decompression and internal fusion were performed for 3 patients with aneurysmal bone cysts. Of the 23 patients, 7 underwent dorsal fusion and 4 underwent ventral fusion of the axis body. Chemotherapy was necessary for the patients with eosinophilic granuloma with multifocal disease and for the patient with Ewing's sarcoma. There was no morbidity, and there were no deaths. All patients with benign lesions were free of disease at the time of the follow-up visit (mean ± SD follow-up 8.8 ± 1.1 years; range 2–18 years). Chordomas received proton or LINAC irradiation, and as of 4–15 years of follow-up, no recurrence has been noted. Conclusions Because most atlantoaxial tumors in children are benign, an intralesional procedure could suffice. Vascular control and staged resection are critical. Ventral transoral fusion or lateral extrapharyngeal fusion has been successful. Resection with ventral fusion and reconstruction are essential for vertebral body collapse. Management of eosinophilic granulomas must be individualized and might require diagnosis through needle biopsy.

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Section: Primary Bone Tumors Affecting the Atlantoaxial Skeleton Of Cmentioning

confidence: 99%

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Menezes¹,

Ahmed²

2014

PED

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“…A disease of growing bone, affecting males more frequently than females (2.5:1), OCs typically present in younger patients during the 2nd to 3rd decades of life; however, it has also been described in the 8th decade 4 9 10. Our patient presented in his second decade which is the commonest age of presentation.…”

Section: Discussionmentioning

confidence: 68%

“…Due to a low rate of malignant transformation, asymptomatic SOC can be followed conservatively 10. When the tumour causes pain or neurological complications due to compression, or the diagnosis is indefinite, it should be excised at its base.…”

Section: Discussionmentioning

confidence: 99%

Solitary osteochondroma of the atlas causing spinal cord compression: a case report and literature review

et al. 2012

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A new case of spinal cord compression by an isolated osteochondroma (OC) of the spinal canal arising from the posterior arch of the atlas is added to the 15 previously reported cases in the English-language medical literature. CASE PRESENTATIONA 16-year-old male, with no signifi cant family history, presented with a history of suboccipital headache and progressively increasing quadriparaesis for duration of over 6 months with no bladder or bowel dysfunction. Physical examination revealed spastic quadriparaesis grade 4. INVESTIGATIONSCervical CT scan with 3D reconstruction ( fi gure 1 ), following a questionable plain radiograph, showed an intraspinal OC arising from the posterior arch of the atlas in the midline protruding into the spinal canal. MRI ( fi gure 2 ) showed signifi cant compression of the spinal cord with high signal intensity of the cord at C1 level.

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“…As emerging from the literature, spinal OCs are rarely seen in elderly patients as the case here described 3 9 15. The pathological mechanisms governing their development in this age group are still not settled.…”

Section: Discussionmentioning

confidence: 82%

Solitary lumbar osteochondroma presenting with spinal cord compression

Natale

Rotondo²,

D'Avanzo³

et al. 2013

BMJ Case Reports

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We report a case of a middle-aged woman with a solitary osteochondroma of the L2 right lamina with intraspinal extension and spinal cord compression. The case is unusual in terms of localisation and age at clinical presentation. In fact, spinal osteochondromas as solitary lesions—especially when affecting the lumbar segment—are rare tumours of a maturing adolescent skeleton, infrequently affecting the neurological structures, because most of the lesions grow out of the spinal canal. Although unusual, they should be considered in the differential diagnosis. Prompt and accurate radiological investigations are important in planning appropriate management. Surgical total excision is the best treatment modality to remove spinal cord and/or nerve root compression, and to avoid the risk of recurrence or malignant transformation.

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A rare case of solitary osteochondroma of the dens of the C2 vertebra

Abstract: We report an extremely rare case of a 22-year-old man with an asymptomatic osteochondroma of the dens of C2 vertebra accidentally found during a brain CT scan examination.

Cited by 27 publications

References 6 publications

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Solitary osteochondroma of the atlas causing spinal cord compression: a case report and literature review

Solitary lumbar osteochondroma presenting with spinal cord compression

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