Osteochondroma of the axis : letter to editor.

K Sridhar, B Ramamurthi 
 

Correspondence Address:
K Sridhar

Full Text



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.

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