You are here

Article Text

Article menu

Download PDFPDF

Giant spinal exostosis
Free
  1. Chandramohan Sharma,
  2. Mihir Acharya,
  3. Bansi Lal Kumawat,
  4. Jigar Parekh
  1. Department of Neurology, Sawai Mansingh Medical College and Hospital, Jaipur, Rajasthan, India
  1. Correspondence to Professor Chandramohan Sharma, cmsharma65{at}hotmail.com

https://doi.org/10.1136/bcr-2014-203819

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Description

    A 20-year-old man presented with an 11-year history of insidious onset gradually progressive, painless swelling at the nape of the neck. The swelling had been asymptomatic all these years, except for its peculiar appearance. On examination the cervical region swelling was non-tender, bony, hard and immobile with normal overlying skin and no restriction of neck movements (figure 1). There were no focal neurological deficits. CT of the cervical spine showed a large exostosis of the posterior spinous processes of C7 and T1 vertebrae (figure 2). The patient was managed with surgical resection of the exostosis and excision histopathology confirmed the diagnosis of osteochondroma.

    Figure 1
    Figure 1

    Giant cervical spine exostosis—hard, bony, immobile and non-tender swelling at the nape of neck.

    Figure 2
    Figure 2

    Reconstructed sagittal CT of the cervical spine—giant exostosis of the posterior spinous processes of C7 and T1-weighted vertebrae.

    Exostosis, also called osteochondroma, is considered the most common benign tumour of the bone, with low rate of malignant degeneration between 1% and 5%. Spinal exostoses1 are uncommon, accounting for 1–9% of all exostoses. Within the spine, the lesions almost always occur in the posterior elements,2 hence spinal cord compression is rare. Solitary lesions affect the cervical spine most commonly with a predilection for the atlantoaxial area, followed by the thoracic spine, and then the lumbar region. CT scan is the imaging modality of choice for these lesions. Treatment usually involves surgical resection, especially for symptomatic patients with pain or neurological deficits such as paraparesis, or for cosmetic reasons. Recurrence rate is low. Hence, the rarity of this tumour at this location, with such a large size, makes this article unique.

    Learning points

    • Exostoses are benign bone tumours, which may rarely occur in the spinal vertebrae, affecting the posterior elements.

    • Usually asymptomatic, but they may cause focal pain or neurological symptoms such as paraparesis.

    • CT scan is the investigative modality of choice and surgical resection is the treatment modality of choice.

    References

    1. ↵
      1. Abbas M,
      2. Khan AQ,
      3. Siddiqui YS,
      4. et al
      . Young adult and giant cervical exostosis. Saudi Med J 2011;32:80–2.
      OpenUrlPubMedWeb of Science
    2. ↵
      1. Rao H,
      2. Jakheria S
      . Giant cervical exostosis: a case report with review of literature. J Pediatr Orthop B 2009;18:103–5.
      OpenUrlCrossRefPubMed
    View Abstract

    Footnotes

    • Contributors The four authors contributed to the planning, conduct and reporting of the work described in the article and are justifiably credited with authorship, according to the authorship criteria. All authors read and approved the final manuscript. CS is the guarantor.

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.