Symptomatic osteochondroma of the spine in elderly patients

Abstract

Whereas osteochondroma is a common benign bone tumor in adolescence, it is rarely observed in elderly patients. It is unknown why osteochondromas, which usually develop during skeletal growth, rarely develop in elderly patients. The authors report 3 cases of symptomatic spinal osteochondroma in elderly patients and discuss the possible reasons for the onset of the enlargement of osteochondromas in elderly patients. Clinical history, radiographs, MR images, and CT myelography studies were obtained in each patient and are described. A review of the relevant literature is also presented. In the first case, the cervical osteochondroma caused spinal canal compression and occipital nerve irritation. It was totally excised, which successfully relieved the pain and allowed the patient to return to normal neurological function. In the second case, total removal of the tumor was effective in alleviating clinical symptoms. In the last case, ablation of the articular facet joint partially relieved the patient's lower-back pain. In the first 2 cases, the patients suffered from psoriasis and associated psoriatic arthritis and in the last case, the patient suffered from HIV-associated psoriatic arthritis. The psoriatic arthritis was characterized as asymmetric chronic multiple-joint arthritis and was HLA B27 positive. The pathology of psoriatic arthritis was the accelerating bone turnover and ankylosis. Symptomatic osteochondroma of the spine in elderly patients is extremely rare since it typically develops during skeletal growth. In this report, the authors show that pathological accelerating bone turnover such as psoriatic arthritis may be a possible mechanism for the onset of the enlargement of osteochondromas in elderly patients. The age of the patients in this report suggests that growth of the osteochondroma continues after skeletal development.