Cervical Cord Compression Due to Osteochondroma in Hereditary Multiple Exostoses: A Case Report and Review of Literature

Hereditary multiple exostoses (HME) is an autosomal dominant skeletal disorder; it is characterized by multiple osteochondromas that usually arise from the metaphyses of long bones.We report the case of a 12year-old boy with familial HME who presented with vertigo, imbalance, and gait ataxia.Examination revealed vertical nystagmus, a positive Romberg's sign, and hyperalgesia below the C2 level with preserved motor power.Magnetic resonance imaging and computed tomography showed a bony outgrowth arising from the right C2 lamina and projecting into the spinal canal, causing posterior extradural compression of the spinal cord without myelomalacia, together with non-union of the anterior and posterior arches of the atlas.He underwent C2 laminectomy with complete excision of the lesion, which arose from the inner surface of the right C2 lamina and extended cranially beneath the right hemiarch of C1.Histopathology confirmed osteochondroma.The postoperative course was uneventful, with no new neurological deficits.This case shows that an intracanal cervical osteochondroma in a child with HME may present with subtle symptoms, such as vertigo and imbalance, rather than overt weakness.Clinicians caring for children with HME should have a low threshold for cross-sectional spinal imaging when new neurological symptoms develop.