Osteochondromas of the cervical spine in atypical location

Schomacher, Markus; Suess, Olaf; Kombos, Theodoros

doi:10.1007/s00701-009-0235-3

Cited by 20 publications

(16 citation statements)

References 24 publications

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“…Thus, there is a preponderance of primary spine tumors at this level among children. Schomacher et al provided a review of osteochondromas through 2007, 62 of which 43% were at the C1-2 level. Because of the preponderance of primary spinal tumors in this region and the early development of neurological deficits caused by local tumor growth patterns, we propose that atlantoaxial tumors in children constitute a distinct clinical entity.…”

Section: Discussionmentioning

confidence: 99%

“…A literature review identified osteochondromas in 40% of solitary benign tumors; a spinal location was noted for 1%-4% of cases. 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.…”

Section: Primary Bone Tumors Affecting the Atlantoaxial Skeleton Of Cmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

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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“…49 There is a male predominance with a 3:1 male to female ratio. Osteochondromas are cartilage-capped bony growths, appearing in relation to the growth plate, and are either broad based or stalked.…”

Section: Osteochondromasmentioning

confidence: 99%

“…51,52 The cervical and thoracic regions are most commonly affected. 49 Clinical presentation: osteochondromas are usually asymptomatic, other than often producing a palpable mass with or without localized tenderness. Most lesions do not protrude into the spinal canal or neural foraminae, therefore neurological complications are uncommon.…”

Section: Osteochondromasmentioning

confidence: 99%

“…Excision of osteochondromas should take into account the risk of injury to adjacent neural elements, visceral organs or blood vessels, as well as the potential need for spinal reconstruction if tumour removal results in structural instability. 49 Most chondrosarcomas developing in the setting of an osteochondroma are low-grade, can be treated with wide resection and have favourable prognosis.…”

Section: Osteochondromasmentioning

confidence: 99%

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Bone tumours affecting the spine in children and adolescents

Mataliotakis

2011

Orthopaedics and Trauma

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Solitary C1 spinal osteochondroma causing vertebral artery compression and acute cerebellar infarct

et al. 2014

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Osteochondroma is a common benign bone lesion, usually involving the long bones. Spinal involvement is rare. The clinical presentation of spinal osteochondroma varies according to the site of the lesion. The most common reported clinical presentation is secondary to encroachment of the lesion on the spinal canal or nerve roots. Less common presentations such as a palpable neck mass, dysphagia, sleep apnea, paralysis of left vocal cord or acute respiratory distress have been reported when the lesions compress the anatomic structures anteriorly. We describe a rare case of a young patient who presented with an emergent critical condition of acute cerebellar infarct as a result of vertebral artery compression caused by a solitary C1 spinal osteochondroma.

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Osteochondromas of the cervical spine in atypical location

Cited by 20 publications

References 24 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

Bone tumours affecting the spine in children and adolescents

Solitary C1 spinal osteochondroma causing vertebral artery compression and acute cerebellar infarct

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