Introduction
The chondroma of the spine is a low-grade, slow-growing, benign (non-cancerous) tumor. The chondroma of the spine or vertebral column is an infrequent entity. The spinal chondroma originates from the mature hyaline cartilage. The chondroma of the spinal column also shows neurological symptoms in patients due to compression of the tumor in the spinal nerves. The chondromas have limited growth and do not significantly increase in size.
How Does Chondroma Occur?
Chondroma develops from the cell nest of developmental cartilages (neural crest cells) that have gotten trapped in the medulla canal of the bone during development. The chromosomal abnormalities associated with chondromas are in 12q13q-q15 chromosomal regions. The chondromas arise from different types of bone tissue where the remnants of the developmental tissues exist.
What Are the Types of Chondromas?
Chondromas, in general, can be divided into four types based on their type of tissue of origin, and they are:
Enchondromas: This chondroma is a painless lesion occurring due to idiopathic causes.
Periosteal Chondromas: These chondromas develop inside or below the outer layer of the bony connective tissue. This type of chondromas is slow-growing in rate, eroding in nature, and shows a popcorn appearance during imaging.
Synovial Chondromas: This occurs due to increased growth of the cartilage tissues. It appears as an abraded cellular lesion.
Osteochondroma: This chondroma occurs due to the loss of the distal part of the 8q (long arm) chromosome and is associated with a genetic defect of the genes EXT1 and EXT2.
What Is the Incidence Rate of Spinal Chondroma?
Spinal chondroma is a very rare condition. It is commonly seen affecting people aged 40 to 60 years, with an increased incidence in male patients than in females, with a ratio of 2:1 and a yearly occurrence rate of 1:1000000. The spinal chondromas account for about 20 percent of the overall spinal tumors and 3 percent of overall bone tumors. The distribution of chondromas in the spine is around 50 percent in the sacral region and 15 percent in the vertebral bodies, and 35 percent in the spine at the base of the skull. The most commonly involved spinal bones are the C2 cervical vertebrae, followed by the lumbar(spinal bone in the lower back) and thoracic (spine in the chest).
How Are Chondromas of the Spine Seen Clinically?
In the clinical case of chondroma, patients experience severe back pain with loss of function of the legs or arms or loss of sensations in the extremities due to compression of the spine by the tumor. The other clinical signs include weakness of the limbs, lack of clarity in speech, and difficulty swallowing.
How Is Spinal Chondroma Evaluated?
The evaluation of spinal chondroma is done using imaging and biopsies. The imaging methods used for diagnosing spinal chondroma are:
Radiographic Images (X-Rays):
Radiographs are two-dimensional images that produce an image through X-rays. In spinal chondromas, the X-rays show a well-lined lesion that appears with multiple cell breakdowns.
Computed Tomography (CT): CT scans are imaging techniques that use special radiation instruments to produce detailed images or scans of areas inside the body. It is a three-dimensional image that gives an idea of the issues from all sides and detects minor abnormalities in a better way. The chondromas in CT scans show radiolucent (more dark) images that appear erosive.
Magnetic Resonance Imaging (MRI): This imaging type uses a magnetic field and radio waves to record the body function and create images. In the case of spinal chondromas, MRI clearly demonstrates more hyaline cartilages and high water content.
Biopsy: Biopsies are done as confirmatory tests where the lesion is examined by extracting the contents of the tumor through needles, also called needle biopsies. In this case, open biopsies are not easy as it involves opening up of the vertebrae. Wide bore needles are used to extract the contents from the tumors.
How Is Spinal Chondroma Treated?
Spinal cord tumors can be externally or internally located tumors that can be treated in two ways:
Non-Surgical Management:
The primary management of spinal chondroma is pain management using non-steroidal painkillers and compression. The other non-surgical methods of treatment include chemotherapy and radiation therapy. Both these methods of treatment can be temporarily effective in managing patients. Radiation therapy is recommended for patients where tumor excision is impossible. However, all these treatments are preferred as non-surgical treatment, and there is still a compromised outcome and a rapid recurrence rate.
Surgical Management:
The surgical management of spinal chondroma is one of the most preferred forms of treatment. Though the position of the tumor may be complicated, it still shows better results compared to non-surgical management. Surgical management is done by excising the entire tumor from the compression area. Surgical management shows comparatively a better result than medical management of the tumor.
What Are the Conditions That Resemble Spinal Chondroma?
The conditions which resemble spinal chondroma are:
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Chondrosarcoma - A type of sarcoma that closely resembles the spinal chondroma without involving the brachyury gene.
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Giant cell tumors of the bone (a benign bone tumor occurring in young adults).
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Plasmacytoma (cancer originating from the plasma cells or antibody-producing white blood cells).
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Tumor metastasis (tumor spread) in the spine.
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Tumors of the spinal lymph nodes.
How Is the Prognosis of Spinal Chondroma?
The prognosis of spinal chondroma is less likely favorable as it is scarce and irrespective of the treatment provided, the remnant cells do tend to exist, which causes recurrence.
Conclusion
Spinal chondroma is a rare condition that occurs in the cervical area. Spinal chondromas are found in young males causing pain and loss of sensation due to the compression exerted by the tumor on the spinal nerves. Various surgical and non-surgical treatment modalities are available for treating chondromas of the spine, but the tumors still show a ten percent recurrence rate. Though it is benign, continuous monitoring of the tumor is done to assess the growth and prevent neurological symptoms. Although chondromas of the spine cannot be completely eradicated, they can be managed precisely with the right approach.
