Pedunculated Exostosis of the Pedicle of Lumbar Vertebra: A Rare Cause of Lumbar Pain and Swelling.

INTRODUCTION

Osteochondroma is a common benign bone tumor, but its occurrence in the spine is rare, particularly in the lumbar region. Among spinal osteochondromas, involvement of the pedicle is uncommon. This case highlights a rare presentation of a pedunculated exostosis arising from the right pedicle of the first lumbar vertebra (L1) with a fracture at its base, leading to persistent lumbar pain and swelling. Given its potential for neurological compromise and malignant transformation, timely recognition and surgical intervention are crucial.

CASE REPORT: A 19-year-old male presented with a progressively painful swelling in the lumbar region for 5 years. He had no history of trauma or systemic illness. Examination revealed tenderness over the right paraspinal area of the upper lumbar region with a palpable bony mass. Magnetic resonance imaging showed a pedunculated bony lesion arising from the right pedicle of L1, projecting postero-superiorly, with a fracture at its base. The patient underwent surgical excision through a posterior approach. Histopathology confirmed the diagnosis of osteochondroma. Postoperatively, the patient experienced significant symptom relief, with no recurrence on regular follow-ups.

CONCLUSION

This case underscores the importance of considering spinal osteochondroma in young patients with chronic lumbar pain and swelling. Although rare, spinal osteochondromas can lead to fractures, neurological compression, and potential malignant transformation, surgical excision provides definitive treatment, relieving symptoms and preventing complications. Reporting such cases enhances awareness and guides timely diagnosis and management.