Large solitary osteochondroma of the thoracic spine: Case report and review of the literature

BACKGROUND: Spinal osteochondromas are typically benign tumors, but patients may present with myelopathy and neurologic deficits if there is tumor encroachment within the spinal canal. CASE DESCRIPTION: We report here a case of a large solitary osteochondroma originating from the posterior vertebral body of T9 causing spinal cord compression and myelopathy. A 17-year-old man presented with 3 months of bilateral feet numbness and gait difficulty. Imaging demonstrated a large left-sided 5.9 cm × 5.0 cm × 5.4 cm osseous mass arising from the T9 vertebra consistent with an osteochondroma. He underwent bilateral costotransversectomies, and a left two-level lateral extracavitary approach for three partial corpectomies to both safely decompress the spinal canal as well as obtain a gross total resection of the tumor. Use of the O-arm intraoperative stereotactic computed tomographic navigation system assisted in delineating the osseous portions of the tumor for surgical removal. He experienced complete neurologic recovery after operative intervention. CONCLUSION: Careful surgical planning is needed to determine the best approach for spinal cord decompression and resection of this tumor, especially taking into account the bony elements from which it arises. We present this case, to highlight the feasibility of a single-stage posterior approach to the ventral thoracic spine for the resection of a large solitary thoracic osteochondroma causing cord compression.