Rare case of osteochondroma in the spinous process of the fifth cervical vertebra in a pediatric patient with multiple hereditary exostoses

Introduction: Spinal osteochondromas develop from aberrant endochondral ossification of the vertebrae, which originate from the sclerotome of the paraxial mesoderm. These tumors typically involve the posterior elements, such as the spinous process, lamina, or pedicles. Spinal osteochondromas are rare, constituting less than 2% of all osteochondromas and under 4% of spinal tumors. Presentation of case: A 7-year-old boy came to the clinic with a lump at the back of the neck and difficulty moving his head, which was diagnosed as osteochondroma at the fifth cervical vertebra (C5). The child also had a history of multiple hereditary exostoses affecting other parts of the body. Discussion: Spinal osteochondromas account for a small percentage of cases, with the cervical spine being the most frequently affected. Diagnosis relies on computed tomography for precise visualization, aiding in preoperative planning. The etiology involves genetic mutations in EXT1 and EXT2, with additional mechanical factors possibly contributing to cervical spine involvement. This case contributes valuable insights into pediatric spinal osteochondromas, underscoring the need for timely diagnosis to prevent complications. Conclusion: Osteochondromas are considered the most common benign tumors. However, spinal osteochondromas are very rare, particularly in pediatric patients. This case underscores the importance of recognizing osteochondroma as a differential diagnosis for neck masses in children. Early diagnosis and surgical intervention can prevent complications and recurrence, highlighting the clinical significance of this rare condition. This report also emphasizes the necessity of vigilant postoperative follow-up to ensure complete recovery and monitor for potential complications.