Paraparesis caused by rib exostosis in a child with Down syndrome: a case report

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2008-11, Vol.33 (23), p.E911-E913
• Main Authors: Mannoji, Chikato, Yamazaki, Masashi, Kamegaya, Makoto, Saisu, Takashi, Minami, Shohei, Takahashi, Kazuhisa
• Format: Article
• Language: English
• Subjects: Bone Neoplasms - complications; Bone Neoplasms - pathology; Bone Neoplasms - surgery; Child; Down Syndrome - complications; Down Syndrome - pathology; Exostoses - complications; Exostoses - pathology; Exostoses - surgery; Humans; Magnetic Resonance Imaging; Male; Osteochondroma - complications; Osteochondroma - pathology; Osteochondroma - surgery; Paraparesis - etiology; Paraparesis - pathology; Paraparesis - surgery; Ribs - pathology; Spinal Cord Compression - etiology; Spinal Cord Compression - pathology; Spinal Cord Compression - surgery; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0b013e3181845b56

Case report. We describe a case of paraparesis caused by a rib exostosis compressing the spinal cord. Exostoses are the most common benign tumors of bone and often arise from the metaphyses of long bones. Spinal exostoses are uncommon lesions, but when present, may compress the spinal cord and cause significant neurologic symptoms. Spinal exostoses leading to neurologic impairment typically arise from vertebrae or laminae. It is very rare for exostoses originating from rib heads to cause neurologic symptoms. The patient's medical and radiographic history is reviewed as well as the relevant medical literature. A 10-year-old boy with multiple exostoses and Down syndrome was referred to our hospital because of difficulty walking. Careful physical examination revealed that his gait disturbance was because of paraparesis. Radiographs, computed tomography scan, and magnetic resonance imaging revealed that an exostosis arising from the left eighth rib head was compressing the spinal cord. The exostosis was resected and the patient's neurologic symptoms resolved. Exostosis rising from the rib head can compress the spinal cord and cause neurologic deficits. Surgical resection of the rib exostosis should be strongly considered when neurologic symptoms develop.