Course of spinal solitary osteochondromas

Study Design. Six spinal solitary osteochondromas. Objectives. To evaluate the course of spinal cord compression after surgery, and the risk of local recurrence and malignant transformation, based on the present series and cases reported in the literature. Summary of Background Data. Spinal cord compression by a solitary osteochondroma is rare. Little is known concerning neurologic improvement after decompression of the spinal cord or the risk of recurrence or malignant transformation of spinal solitary osteochondroma, because most of the cases reported are isolated. Methods. Clinical history, plain radiographs, pathologic features, computed tomographic studies, and magnetic resonance imaging were reviewed. Five patients underwent long-term follow-up physical examination and computed tomography for an average of 6 years ( range, 2-12 years) after surgical treatment. The literature was reviewed for solitary osteochondroma with spinal cord compromise, recurrent solitary osteochondroma, or solitary osteochondroma in the process of sarcomatous transformation. Results. In the present study, two of the six patients experienced spinal cord compromise. Neurologic deficits improved after surgery. None of the patients had local recurrence or malignant transformation at follow-up observation. Including these two patients, the authors found 62 cases of solitary osteochondroma with spinal cord compromise in the literature. Overall, three patients died, eight did not improve, and 48 (81%) experienced regression of the neurologic deficit after surgical decompression. Among the 150 cases of solitary osteochondroma the authors found in the literature, there were six cases (4%) of local recurrence and four cases (2.7%) of malignant transformation. Conclusions. Surgical treatment improves neurologic deficit in more than 80% of cases of spinal cord compromise caused by solitary osteochondroma. The risk of recurrence or sarcomatous transformation justifies clinical and radiologic follow-up review.