A rare presentation of cervical osteochondroma arising in a spinous process

The case of a 21-year-old woman with a palpable neck mass is reported.

To describe the rare presentation of an osteochondroma arising in the right bifid tip of the C5 spinous process presenting as a palpable neck mass. Emphasis will be placed on the pathophysiology, symptomatology, complications, imaging, and surgical management.

Osteochondromas rarely occur in the cervical spine and lesions arising from the neural arch may present as a palpable neck mass.

The patient's medical and imaging history and medical literature were reviewed.

A 21-year-old woman presented with a hard palpable mass in her lower cervical spine. Review of radiography, CT, MRI, and skeletal scintigraphy demonstrated an expansile bone lesion arising in the right bifid tip of the C5 spinous process with dense chondroosseous matrix in the distal tip of the lesion. Wide C5 laminectomy with en bloc resection of the tumor alleviated her symptoms. Biopsy revealed osteochondroma without malignant degeneration.

Patients with cervical spine osteochondromas may present with a multitude of symptoms and complications depending on the size and location of the lesion. These may include pathologic fracture, spinal stenosis, nerve root compression, cranial nerve deficits, myelomalacia, and malignant degeneration to chondrosarcoma. Advanced imaging modalities are required for characterization, diagnosis, surgical planning, and management of these rare spinal lesions.