Solitary osteochondroma of the cervical spine causing spinal cord compression

Osteochondromas are common benign tumours of bone that often occur in the metaphysodiaphyseal parts of long bones. They rarely occur in the spine. We present a case of solitary osteochondroma arising from the C-1 vertebral lamina, causing neurological symptoms. A 46-year-old man presented to our institution, complaining of pain and numbness originating from his neck and extending down to his left arm. Radiographs, CT and MRI showed a solitary benign appearing expansile bone tumour arising from the left vertebral lamina of C-1, spreading to C-2, exerting an eccentric posterolateral compression on the spinal cord in the left part of the spinal canal and causing stenosis of the left neural foramen between C-1 and C-2. The lesion was surgically explored through a posterior longitudinal incision. Leaving the left lateral mass of C-1 intact, a left hemilaminectomy was performed. The lesion and the part spreading to C-2 were excised, completely clearing the spinal cord compression. For posterior stabilisation, lateral mass screws were inserted bilaterally in C-1 and pedicle screws and a rod system were used in C-2. The interlaminar region between C-1 and C-2 was fused using cancellous allograft chips. Follow-up controls with radiological examination revealed that the decompression had been adequate and fusion was achieved. Excision of the lesions is necessary to relieve neurological compression in such cases. In order to avoid complications associated with instability following extensive laminectomy, posterior stabilisation and fusion should also be performed.