Intraspinal periosteal chondroma in upper thoracic spine causing cord compression and myelopathy: A case report

Abstract

Introduction: Chondromas are slow-growing cartilage-forming benign tumors, rarely occurring in the spine. Generally, most spinal chondromas are asymptomatic; however, with slow progressive growth, these lesions may enlarge and expand and cause compressive neurological symptoms, resulting in radiculopathy or more commonly myelopathy due to direct neural compression.

Presentation of case: A 15-year-old male adolescent presented to Emergency Department with history of fall (slippage) on concrete ground while playing three months back. On neurological examination, the motor power in bilateral upper limbs was 5/5 while it was 1/5 in both lower extremities. Some muscle wasting was noted in the lower limbs. The planter reflexes were upgoing; and the sensory loss was below T6 spinal level. CT scan of dorsolumbar spine demonstrated a well-defined high-density lesion in lateral aspect of spinal canal at T2-T3 vertebral level adjacent to left T2-T3 facet joint. MRI of dorsal spine revealed a 3 × 2 × 1 cm³-sized, well-defined, non-enhancing T1 low to isointense and T2/STIR heterogeneous hyperintense lesion with osseous and cartilaginous components in the left lateral aspect of spinal canal at T1-T3 level, causing compression and contralateral displacement of spinal cord. The patient was then subjected to posterior laminectomy, complete excision, followed by laminoplasty using minicranial plates and screws. Histopathology of the mass showed bony trabeculae with hematopoietic elements and attached lobules of hyaline cartilage, chondroid matrix and lobules of mature chondrocyte and myxoid changes. Postoperatively his power was improved slightly and he was able to stand up with some assistance. On six-month follow up, patient showed significant neurological improvement. He was able to walk independently with minimal assistance. He was able to control bowel and bladder functions.

Discussion: Chondromas occurring in the spine are rare, accounting for only about 3% of all chondromas. Spinal chondromas are commonly encountered in the thoracic spine as in our case.

Conclusion: Complete en bloc surgical excision is generally recommended as the treatment of choice for cases with local and/or neurological symptoms.

Keywords: Case report; Complete excision; Dorsal spine; Myelopathy; Periosteal chondroma.

Fig. 1

CT scan showing a well-defined high-density lesion (white arrow) within the lateral aspect of spinal canal at T2-T3 vertebral level adjacent to left T2-T3 facet joint causing spinal canal compromise and cord compression, (A) axial and (B) sagittally-reconstructed images.

Fig. 2

MRI demonstrating a well-defined, non-enhancing heterogeneous signal lesion (black arrow) with osseous and cartilaginous components in left lateral aspect of spinal canal at T1-T3 level with compression and contralateral displacement of spinal cord. (A) sagittal and (B) axial sequences.

Fig. 3

Intraoperative specimen showing whitish-reddish cartilaginous lesion. Note the fibrous tissue covering.

Fig. 4

Postoperative MRI (T2-weighted images) showing some postoperative changes without any residual or recurrence and good decompression with acceptable spinal alignment. (A) Sagittal and (B) Axial sequences.

Fig. 5

Histopathology: bony trabeculae with hematopoietic elements and attached lobules of hyaline cartilage, chondroid matrix and lobules of mature chondrocyte and myxoid changes.