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Late presentation of spinal cord compression in hereditary multiple exostosis: case reports and review of the literature

INTRODUCTION: Osteochondromas are usually found in the long bones of patients with hereditary multiple exostoses (HME). The spine is reported to be involved in over 50% of cases, but few of these patients are symptomatic as the result of an existing spinal exostosis. METHODS: We reviewed the current...

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Autores principales: Gigi, R., Kurian, B. T., Cole, A., Fernandes, J. A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The British Editorial Society of Bone & Joint Surgery 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808079/
https://www.ncbi.nlm.nih.gov/pubmed/31695813
http://dx.doi.org/10.1302/1863-2548.13.180130
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author Gigi, R.
Kurian, B. T.
Cole, A.
Fernandes, J. A.
author_facet Gigi, R.
Kurian, B. T.
Cole, A.
Fernandes, J. A.
author_sort Gigi, R.
collection PubMed
description INTRODUCTION: Osteochondromas are usually found in the long bones of patients with hereditary multiple exostoses (HME). The spine is reported to be involved in over 50% of cases, but few of these patients are symptomatic as the result of an existing spinal exostosis. METHODS: We reviewed the current literature in order to find the right approach to patients with HME-complicated spinal exostosis and describe three paediatric patients that were diagnosed late with spinal cord compression due to cervical exostosis. RESULTS: Our three cases were all late presentations with neurology and unfortunately had minimal improvement of neurology after the lesion was surgically removed. There is general agreement that late presentation of spinal cord injury due to osteochondromas involving the cervical spine may cause severe and irreversible neurological sequelae. Our literature review revealed that there are no clear-cut guidelines to develop more comprehensive screening measures for these patients. CONCLUSIONS: A high index of suspicion is the most important factor for correct diagnosis and appropriate management. Physicians who treat HME should bear in mind that thorough history taking and a neurological examination at follow up are essential for these patients. Clearer guidelines for the development of more comprehensive screening programmes are essential. LEVEL OF EVIDENCE: IV
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spelling pubmed-68080792019-11-06 Late presentation of spinal cord compression in hereditary multiple exostosis: case reports and review of the literature Gigi, R. Kurian, B. T. Cole, A. Fernandes, J. A. J Child Orthop Original Clinical Article INTRODUCTION: Osteochondromas are usually found in the long bones of patients with hereditary multiple exostoses (HME). The spine is reported to be involved in over 50% of cases, but few of these patients are symptomatic as the result of an existing spinal exostosis. METHODS: We reviewed the current literature in order to find the right approach to patients with HME-complicated spinal exostosis and describe three paediatric patients that were diagnosed late with spinal cord compression due to cervical exostosis. RESULTS: Our three cases were all late presentations with neurology and unfortunately had minimal improvement of neurology after the lesion was surgically removed. There is general agreement that late presentation of spinal cord injury due to osteochondromas involving the cervical spine may cause severe and irreversible neurological sequelae. Our literature review revealed that there are no clear-cut guidelines to develop more comprehensive screening measures for these patients. CONCLUSIONS: A high index of suspicion is the most important factor for correct diagnosis and appropriate management. Physicians who treat HME should bear in mind that thorough history taking and a neurological examination at follow up are essential for these patients. Clearer guidelines for the development of more comprehensive screening programmes are essential. LEVEL OF EVIDENCE: IV The British Editorial Society of Bone & Joint Surgery 2019-10-01 /pmc/articles/PMC6808079/ /pubmed/31695813 http://dx.doi.org/10.1302/1863-2548.13.180130 Text en Copyright © 2019, The author(s) http://creativecommons.org/licenses/by-nc/4.0/ Open Access This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.
spellingShingle Original Clinical Article
Gigi, R.
Kurian, B. T.
Cole, A.
Fernandes, J. A.
Late presentation of spinal cord compression in hereditary multiple exostosis: case reports and review of the literature
title Late presentation of spinal cord compression in hereditary multiple exostosis: case reports and review of the literature
title_full Late presentation of spinal cord compression in hereditary multiple exostosis: case reports and review of the literature
title_fullStr Late presentation of spinal cord compression in hereditary multiple exostosis: case reports and review of the literature
title_full_unstemmed Late presentation of spinal cord compression in hereditary multiple exostosis: case reports and review of the literature
title_short Late presentation of spinal cord compression in hereditary multiple exostosis: case reports and review of the literature
title_sort late presentation of spinal cord compression in hereditary multiple exostosis: case reports and review of the literature
topic Original Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808079/
https://www.ncbi.nlm.nih.gov/pubmed/31695813
http://dx.doi.org/10.1302/1863-2548.13.180130
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