What are osteochondroma (exostosis) spinal tumors?

Answer

Osteochondromas make up 4% of all solitary spine tumors.^[19] They also are commonly referred to as exostosis. Spinal lesions are encountered in 7-9% of patients with multiple hereditary exostoses (MHE). Osteochondromas occur in patients aged 20-30 years. Patients with MHE tend to develop the osteochondroma at a younger age; they also tend to experience neurologic deficits and myelopathy more frequently (77% of the time) than the patient with solitary osteochondroma (34%). A male predominance exists.

Osteochondromas are more common in the cervical spine, especially at C2. The posterior elements usually are involved. The lesions are believed to arise secondary to trapping of the physeal cartilage outside the growth plate during skeletal development.

Making the diagnosis of osteochondroma in the spine on plain radiography can be difficult unless the lesion is large and protruding posteriorly from a spinous process. In fact, 15% of patients with osteochondromas of the spine have normal appearing x-rays. CT is the study of choice for detecting the exostosis and determining its relation to the surrounding soft tissue and spinal canal.

T1-weighted MRI reveals a central area of high signal intensity, which represents yellow marrow. This area has intermediate intensity on T2-weighted images. The cortex of the exostosis has low signal intensity. The hyaline cartilage cap of the exostosis is best evaluated with MRI and appears with low signal intensity on T1 and high intensity on T2. The cartilage cap should be less than 2 cm in adults. Lesions with cartilage caps greater than 2 cm should be suspected of malignant transformation to chondrosarcoma.

Qualitatively, the bone composing an osteochondroma is normal. Abnormal bone growth occurs at and as a result of the cartilage cap. A continuity of the lesion with the marrow and cortex of the underlying bone is present. The exostosis may be sessile or pedunculated.

Complete surgical resection is usually curative. Clinical symptoms improve in 89% of patients following removal of the exostosis. Incomplete resection can lead to recurrence of the lesion.

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Media Gallery

Spinal tumors. Chordoma histology.
Spinal tumors. Higher magnification of chordoma histology demonstrates characteristic physaliferous cells.
Spinal tumors. Aneurysmal bone cyst histology.
Spinal tumors. Coned-down view of lateral thoracic spine in patient with chondrosarcoma.
Spinal tumors. Axial CT scan at level of chondrosarcoma seen on previous x-ray image.
Spinal tumors. T2-weighted MRI scan of chondrosarcoma in same patient.
Spinal tumors. Photograph of patient's back at time of surgery, exhibiting course of definitive incision to excise chondrosarcoma en bloc with previous biopsy tract included with resection.
Spinal tumors. Histology of chondrosarcoma at 40 times magnification.
Spinal tumors. Lateral cervical spine x-ray demonstrating osteoblastoma in posterior elements of C3 and C4.
Spinal tumors. MRI of osteoblastoma in posterior elements of C3 and C4 seen on previous x-ray image.
Spinal tumors. Histology of osteoblastoma at low magnification.
Spinal tumors. Higher magnification of osteoblastoma.
Spinal tumors. Coned-down view of hemangioma in thoracic spine.
Spinal tumors. Axial CT scan of hemangioma in lumbar vertebra.
Spinal tumors. Axial CT scan of thoracic vertebra, which demonstrates nidus of osteoid osteoma in posterior elements.

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Author

Andrew A Sama, MD Associate Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College; Associate Attending Orthopedic Surgeon, Associate Director of Spine Surgery Fellowship, Hospital for Special Surgery; Associate Attending Orthopedic Surgeon, New York-Presbyterian Hospital

Andrew A Sama, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: DePuy Spine; Clariance, Inc.<br/>Received royalty from Orthodevelopment Corporation for implant design & development; Received consulting fee from DePuy Synthes for consulting; Received royalty from Pagoda Pedicle Screw System for inventor/designer; Received consulting fee from Clariance, Inc. for advisory board/consultant; Received ownership interest from Paradigm Spine, LLC, and Sentio LLC for investment interest; Received grant/research funds from Spinal Kinetics for principal investigation paid to institution.

Coauthor(s)

Federico P Girardi, MD Associate Professor of Orthopaedic Surgery, Weill Medical College of Cornell University; Associate Attending Orthopaedic Surgeon, The Hospital for Special Surgery; Director of Research, Spinal Surgical Service, The Hospital for Special Surgery

Federico P Girardi, MD is a member of the following medical societies: Medical Society of the State of New York

Disclosure: Nothing to disclose.

Frank P Cammisa, MD Chief, Spine Service, Associate Attending Orthopedic Surgeon, Assistant Scientist, Research Division, Hospital for Special Surgery; Associate Professor, Department of Surgery (Orthopedics), Weill Cornell Medical College; Assistant Attending Surgeon, New York Hospital

Frank P Cammisa, MD is a member of the following medical societies: American Association for the Advancement of Science, American Medical Association, American Spinal Injury Association, Eastern Orthopaedic Association, Medical Society of the State of New York, New York Academy of Sciences, New York County Medical Society, North American Spine Society

Disclosure: Received royalty from Nuvasive, Inc. for consulting; Received consulting fee from Alphatec Spine, Inc., Centinel Spine, Inc., Disc Motion Technologies, Inc., Healthpoint Capital Partners, LP., IVY Healthcare Partners, LP., Mazor Surgical Technologies, Nuvasive, Inc. Orthogem, Ltd., Orthovita Inc., Paradigm Spine, LLC., Spinal Kinetics, Spinal Partners III, Viscogliosi Brothers, LLC. for consulting; Received ownership interest from Alphatec Spine, Inc., BI Members, LLC, Centinal Spine, Inc., Dis.

Darren R Lebl, MD Clinical Instructor of Spinal Surgery, Weill Cornell Medical College of Cornell University; Assistant Attending Orthopaedic Surgeon, Hospital for Special Surgery

Darren R Lebl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Neurological Surgeons, North American Spine Society, Scoliosis Research Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

William O Shaffer, MD Orthopedic Spine Surgeon, Northwest Iowa Bone, Joint, and Sports Surgeons

William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Kentucky Medical Association, North American Spine Society, Kentucky Orthopaedic Society, International Society for the Study of the Lumbar Spine, Southern Medical Association, Southern Orthopaedic Association

Disclosure: Received royalty from DePuySpine 1997-2007 (not presently) for consulting; Received grant/research funds from DePuySpine 2002-2007 (closed) for sacropelvic instrumentation biomechanical study; Received grant/research funds from DePuyBiologics 2005-2008 (closed) for healos study just closed; Received consulting fee from DePuySpine 2009 for design of offset modification of expedium.

Chief Editor

Jeffrey A Goldstein, MD Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Director of Spine Service, Director of Spine Fellowship, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, NYU Langone Medical Center

Jeffrey A Goldstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, AOSpine, Cervical Spine Research Society, International Society for the Advancement of Spine Surgery, International Society for the Study of the Lumbar Spine, Lumbar Spine Research Society, North American Spine Society, Scoliosis Research Society, Society of Lateral Access Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Medtronic, Nuvasive, NLT Spine, RTI, Magellan Health<br/>Received consulting fee from Medtronic for consulting; Received consulting fee from NuVasive for consulting; Received royalty from Nuvasive for consulting; Received consulting fee from K2M for consulting; Received ownership interest from NuVasive for none.

Additional Contributors

Lee H Riley III, MD Chief, Division of Orthopedic Spine Surgery, Associate Professor, Departments of Orthopedic Surgery and Neurosurgery, Johns Hopkins University School of Medicine

Disclosure: Nothing to disclose.

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