Case Report
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World J Neurol. Sep 28, 2013; 3(3): 79-82
Published online Sep 28, 2013. doi: 10.5316/wjn.v3.i3.79
Complete recovery of severe tetraparesis after excision of large C1-osteochondroma
Essam A Elgamal
Essam A Elgamal, Neurosurgery Department, Mafraq Hospital, Abu Dhabi 2951, United Arab Emirates
Author contributions: Elgamal EA solely contributed to this manuscript.
Correspondence to: Essam A Elgamal, FRCS (SN), Consultant Pediatric Neurosurgeon, Neurosurgery Department, Mafraq Hospital, Abu Dhabi 2951, United Arab Emirates. eelgamal@mafraqhospital.ae
Telephone: +97-12-5012417 Fax: +97-12-5011833
Received: March 21, 2013
Revised: April 17, 2013
Accepted: May 7, 2013
Published online: September 28, 2013
Abstract

Severe tetraparesis resulting from cervical cord compression due to osteochondroma of the Atlas is a rare condition, especially in young children. In this report, the author discusses the clinical presentation, and outcome of surgical excision of a large C1 osteochondroma presenting with severe myelopathic tetraparesis, in a 10-year-old girl. Computed tomography and magnetic resonance images revealed a large bony lump arising from the posterior arch of atlas, filling most of the spinal canal, and compressing the cervical spinal cord. Another histologically proven exostosis was incidentally found at the spinous process of T1. There was no history of exostosis in the family, and the patient improved dramatically after removal of the C1 osteochondroma.

Keywords: Osteochondroma; Exostosis; Atlas; Tetraparesis; Myelopathy; Recovery

Core tip: Solitary cervical spine osteochondroma affects C1, whereas multiple exostoses involve C2 more. Osteochondroma usually originates from the posterior element, and continues to grow slowly until puberty. It appears in computed tomography as an extradural mass, and spinal cord changes are better seen in magnetic resonance imaging. The author highlighted this case of a child with multiple exostoses arising from the posterior arch of C1 and a smaller one at the spinous process of C7, because the associated severe neurological symptoms are more pronounced than reported previously, and adequate decompression by total excision was associated with significant neurological recovery.