The spine extends from the base of the skull to the tailbone. Spinal exostoses are rare (Figure 1). Spinal cord impingement is also a rare, but documented, complication of MHE. Cervical, thoracic or lumbar region can be affected. Scoliosis secondary to spinal osteochondromas and instability has been reported.
Affects of MHE on the Spine:
This section of the body is not commonly involved with MHE. Involvement of isolated vertebrae has been noted. Affects can range from instability to neural root or cord compression that can manifest as tingling, numbness or weakness in the involved roots or even major neurological deficits like paraparesis or quadriparesis in untreated cases. Rarely compression effects in the form of dysphagia, intestinal obstruction or urinary symptoms may occur.
With any of the red flags mentioned earlier, the orthopedist will perform a thorough spinal and neurological evaluation. Plain x-rays of the spine and if required, advanced imaging may be performed. The presences and extent of the lesion are best delineated with CT, while MRI of the spinal cord demonstrates the area of spinal cord impingement. In rare cases of peripheral nerve compression electromyography may be performed to check status of the nerve.
Possible Treatment Options:
Minor lesions not causing compressive symptoms or neurologic manifestations may be kept under close observation.
Progressive scoliosis and spinal instability may need to be treated with surgical stabilization involving spinal fusion.
What Parents Should Watch Out For:
Any red flags in terms of tingling, numbness, weakness, night pain or bladder and bowel changes and get them evaluated.
Any deformity in the spine or evidence of shoulder or pelvic imbalance.
Gait or posture disturbances. Remember that gait and posture disturbances can be caused by hip or leg exostoses as well (due to either limb-length discrepancy or deformity) and do not necessarily mean tumors in the spine. In any case evaluation by a clinician is important.