A Babashahi, M Panahbekhoda, M Mashari, S Fallahpour
cervical vertebrae corpectomy, chondroma, neoplasm, paravertebral abscess
A Babashahi, M Panahbekhoda, M Mashari, S Fallahpour. Multi Level Cervical Spine Chondroma With Subpriosteal Mass And Abscess. The Internet Journal of Spine Surgery. 2009 Volume 5 Number 2.
Enchondromas (sometimes known as chondromas) are that result from failed migration of chondrocytes. Only about 1% of enchondromas occur in the spine, although they are more common in the setting of Ollier's syndrome or Maffucci's syndrome.(3,4). They can present from the first to sixth decade of life, although they are more common in the second and third decades. There may be a male predominance, although this is controversial.
A 16 years old Iranian female presented with a compliant of neck pain and radiculalar pain to right hand gradually since 4 months ago. On examination, the active range of movement of the cervical spine was painfully decreased by approximately 10 percent of normal. Neurological examination revealed muscle power of 4/5 in proximal and 4/5 in distal parts of the upper extremities. Systemic workup did not reveal evidence of disease elsewhere. Lateral cervical X-ray showed destruction of the C4 body fig (1). MRI revealed a lesion that was hypo- or isointense on T1-weighted images and iso-hyperintense on T2-weighted images. Administration of Gd-DPTA resulted in margin enhancement on T1-weighted images. The noticeable point about this patient was that during mass extraction, a yellowish pus substance was drawn off through corpectomy that mimicked infective problems such as a TB infection, however no infective pathology was reported after laboratory examinations and the pathologic study was compatible with chondroma.
The surgical procedure was conducted in one stage by anterior cervical approach and exposing the C2-C5 vertebrae. C2-C3,C3-C4 and C4-C5 microdiskectomy in addition with anterior total C3 and C4 corpectomy were done, then total resection of the epidural subpriosteal mass and jelly yellowish material were done. Reconstruction was performed using a harvested graft from iliac crest and then was fixed with anterior cervical plate with screw (ADDplus a device consist of titanium cylindrical cage and plate from the Ulrich company) fig(2). The patient didn’t suffer any other new neurological deficits and was able to ambulate with out Philadelphia cervical collar post operatively. After one week she was with out any pain was satisfactory controlled with analgesic medication.
10% to25% of patients with multiple hereditary exostosis have solitary lesions.(7,8)Patients are rarely symptomatic from isolated enchondromas of the spine. However, symptomatic patients can develop a progressive and destabilizing deformity. An enchondroma most often affects the cartilage that lines the inside of the bones. The bones most often involved with this benign tumor are the miniature long bones of the hands and feet.(5). While the exact cause of enchondroma is not known, it is believed to occur either as an overgrowth of the cartilage that lines the ends of the bones, or as a persistent growth of original, embryonic cartilage. Individuals with an enchondroma often have no symptoms due to isolated spinal chondroma However, symptomatic patients can develop a progressive and destabilizing deformity. Plain radiographs may demonstrate a lucency within the vertebral body, but the sensitivity for detection is low. Bone scans are positive if done during skeletal growth.
Treatment for asymptomatic lesions are grafting and instrumentation. Malignant progression to chondrosarcoma must be verified by needle biopsy when suspected.(5,6). When the pain, a palpable mass, or neurological compromise, or the diagnosis is in question, surgery should be considered. Surgery is usually curative and because most tumors stop growing after closure of the epiphyseal plate during puberty, recurrence is rare. Malignant degeneration into chondrosarcoma occurs in 1% to 5%.
While the exact cause of enchondroma is not known, it is believed to occur either as an overgrowth of the cartilage that lines the ends of the bones, or as a persistent growth of original, embryonic cartilage. Specific treatment for enchondroma is determined by a physician based on the age, overall health, and medical history of the patient. If there is no sign of bone weakening or growth of the tumor, observation only may be suggested. However, follow-up with repeat x-rays may be necessary. Some types of enchondromas can develop into malignant, or cancerous, bone tumors later. Careful follow-up with a physician may be recommended.(3,5,7).finally we think some patient with cervical chondroma can mimic epidural abscess, althogh further case study recommend.