Non-Compressive, Disabling, Cervical Radiculopathy and Neck Pain: Cave Osteoid Osteoma

Abstract

Cervical radiculopathy is a common clinical condition with an annual incidence of 85/10,000. Refractory cases with positive disco-vertebral imaging findings are routinely referred to the Neurosurgeon for evaluation and treatment. In the absence of a clearcut compressive etiology, other rarer but surgically curable causes must be considered before recommending conservative management. We discuss the case of an otherwise active, healthy patient with an invalidating, refractory, relapsing nuchal pain and cervical radiculopathy. Only careful and state-of-the-art neuroimaging led to the correct diagnosis: an osteoid osteoma of the right C6 lamina was diagnosed and microsurgically resected allowing complete recovery and cure. The clinical features of these rare tumors in this unusual location are reviewed. The case is relevant for multifold reasons: it draws attention to rare conditions which can mimic radicular compression; emphasizes the need for a careful evaluation and appreciation of specific clinical symptoms and signs associated with non-compressive radiculopathies; prompts planning of a state of the art imaging workup, in order to rule out such an elusive tumor. All these measures minimize the risk of overlooking the present and other rare pathologies, sparing patients a long path of time-consuming, frustrating and cost-ineffective studies and treatment modalities.

Keywords: bone tumors; general neurosurgery; neuro mri; ortho surgery; primary spine tumour; spinal pain.

Figure 1. MRI study.

Sagittal STIR (A) and T1-weighted Gd enhanced axial Dixon (B). Inflammatory changes in and around the spinal canal are clearly highlighted.

Figure 2. High-resolution multiplanar CT study sagittal (A), coronal (B), axial (C, D) show sclerotic thickening of the affected lamina along with the typical "target" appearance of the tumor.

Figure 3. Surgical specimen.

Figure 4. Pathological findings (HH x20) Bony spikes line by a single layer of osteoblasts and interposed richly vascular connective tissue.