Low-grade cartilaginous vertebral tumor: a rare cause of spinal cord compression
Fecha
2023-12-19
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Gavin Publishers
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2574-7754
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Resumen
Introduction: Osteochondroma is the most common benign primary neoplasm, representing up to 36% of benign bone tumors. Its location in the spine is rare, occurring in 4% to 7% of primary tumors in this location, and of these, around one-third present myelopathy secondary to spinal cord compression. Despite its low prevalence described in the literature, in recent years there has been an increase in reported cases. Objectives: To present a rare low-grade cartilaginous tumor with intracanal extension as an etiology of spinal cord compression syndrome with myelopathy. Treatment options were discussed.
Material and Method: Informed consent was approved by the patient. Clinical information and images were obtained from the electronic file. A review of the literature was done for its analysis and discussion. Results: 52-year-old man, no medical history. He consulted for a 2-month history of progressive loss of strength on the left lower extremity (LLE). On physical examination, it presents hypoesthesia and 3/5 strength from L2 to S1 myotomes in the LLE. Neurological evaluation, spine CT, and MRI were done. Images show a T7 vertebral body tumor with a large extruded calcified mass occupying 80% of the canal at T6T7 with severe compression of the spinal cord. Surgical management was decided by performing posterior arthrodesis from T4 to T10 with posterolateral tumor resection and spinal cord decompression. The patient woke up with paraplegia after surgery. There was a gradual and significant improvement in the patient’s condition over the first four weeks. After a 6-month of following an intensive rehabilitation program, the patient progressed favorably, pain-free, with normal sensitivity, full recovery to 5/5 strength, walking independently, and some degree of spasticity. At 2 years follow up the patient has only mild gait disturbance secondary to spasticity.
Discussion: A case of solitary osteochondroma as a cause of progressive compressive myelopathy was presented. Surgical options are evaluated depending on the location of the tumor, presence of mechanical pain, radiographic spinal alignment, vertebral collapse, posterolateral involvement, and neurological compromise of the spine. Most of the similar published reports show that this clinical picture is more frequent in the context of multiple hereditary exostoses and 132 new cases have been published from 2004 to 2016, which shows a 2.4-fold increase since 2003, of which, 27.2% presented with myelopathic symptoms.
Conclusion: Osteochondroma is a rare spine tumor that can produce radicular or myelopathic symptoms. Surgery is recommended in spinal cord compression cases. Surgical options are evaluated depending on the location, morbidity, and complications.
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Citación
Annals of Case Reports, Vol. 8, N° 6 (2023) p. 1-7.
Palabras clave
Cartilaginous, Tumor, Neoplasm, Exostosis, Osteochondroma, Myelopathy, Paraparesis
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Atribución-NoComercial-CompartirIgual 3.0 Chile (CC BY-NC-SA 3.0 CL)