Sporadic osteochondroma of the cervical spine

Osteochondroma is the most common benign tumor of bone, but axial skeleton involvement is uncommon and usually indicates a hereditary cause such as osteochondromatosis (hereditary multiple exostosis). 1 Approximately 7% of hereditary osteochondromas occur along the vertebral column, which is double the rate of vertebral column occurrences among sporadic cases.4 We present a rare pediatric case of a large sporadic osteochondroma arising from the C-3 lamina. A previously healthy 13-year-old girl with no family history of osteochondroma noticed a posterior neck mass that continued to enlarge over the following year. On examination, the mass was readily visible and nontender to palpation. The patient denied clumsiness of the hands or feet, paresthesias, or neck pain. No motor weakness, sensory disturbance, or hyperreflexia was noted. A lateral plain radiograph demonstrated a calcified mass arising dorsally from the posterior elements of the cervical spine between C-2 and C-4 (Fig. 1). Computerized tomography (CT) scans revealed that the mass was arising from the lamina of C-3 with bone remodeling of the C-2 and C-4 laminae (Fig. 2). Magnetic resonance imaging demonstrated a large multilobulated, cystic, and irregularly enhancing mass with calcified components, measuring 5.8 3 5.5 3 8.7 cm and causing mild cord compression at C3?4 (Fig. 2). The differential diagnosis for this rapidly growing spinal bone lesion included osteochondroma, osteoblastoma, osteosarcoma, and chondrosarcoma. The patient underwent a complete resection via a posterior midline cervical incision. At surgery, the tumor appeared lobulated, well-circumscribed, firm, and calcified (Fig. 3). The tumor and the C-3 lamina were removed. The results of a pathological examination were consistent with an osteochondroma. The postoperative CT scan demonstrated a gross-total resection with stable sagittal alignment.