Nonsyndromic Osteochondroma of Lumbar Spine: A Systematic Review of Management and Outcomes with Illustrative Case

Abstract Osteochondromas (OCs) are the most common benign bone tumors, but rarely arise in the lumbar spine. Due to their infrequency, understanding of their clinical presentation, management, and outcomes is limited, with most available data derived from case reports and small series. This systematic review aims to synthesize the literature on nonsyndromic lumbar spine OCs and to present an illustrative institutional case. A systematic search was conducted in PubMed, Embase, Web of Science, and Scopus from database inception to April 2024, following PRISMA 2020 guidelines. Studies reporting clinical cases or series of nonsyndromic lumbar spine OCs with sufficient details on presentation, tumor characteristics, management, and outcomes were included. The risk of bias was evaluated using the Joanna Briggs Institute tools for case reports and case series. Data extraction encompassed demographics, clinical characteristics, tumor features, operative management, and postoperative outcomes. A total of 39 studies encompassing 56 patients were included. The mean age was 42 years; 59% were male. Most lesions originated from the inferior articular process (43%) and commonly affected L4 and L5. The mean lesion size was 29.7 ± 22.2 mm, with significantly smaller lesions in patients with radiculopathy than those with low back pain or palpable mass (p = 0.00034). Radiculopathy (50%) and low back pain (25%) were the most frequent presentations (p < 0.001). The majority (80%) underwent posterior surgical excision without instrumentation, with en bloc resection performed in 78.5%. Complete symptomatic improvement was observed in 94% of patients, and recurrence was rare. Lumbar spine OCs most frequently arise from the inferior articular process and often produce radiculopathy due to intracanalicular growth. Surgical excision—especially en bloc resection—yields excellent outcomes and a low recurrence rate. Conservative treatment may be considered in selected asymptomatic patients. Early recognition and individualized management are essential for optimal outcomes.