Hereditary multiple osteochondromas (HMO) is a common paediatric condition defined by the presence of multiple cartilage-capped bony lesions. Spinal osteochondromas affect up to 68% of HMO patients.1 Although most are asymptomatic, cord-encroaching osteochondromas can lead to significant neurological symptoms and morbidity.2 Limited guidelines exist regarding the use of advanced imaging as a screening modality for spinal osteochondromas. This study aims to evaluate the incidence of spinal osteochondromas detected via advanced imaging in the paediatric HMO population. A systematic review and meta-analysis was conducted following the Cochrane Handbook for Systematic Reviews of Interventions. A search was performed across MEDLINE, Embase, CENTRAL, and CINAHL databases for articles published between May 1, 1946 and May 31, 2024. Included studies reported on the use of advanced imaging, computer tomography (CT) or magnetic resonance imaging (MRI), in HMO patients under the age of 21. The primary outcome was spinal osteochondroma incidence determined by advanced imaging. Secondary outcomes included type of imaging, indication for imaging, symptoms on presentation, incidence of spinal encroaching lesions, incidence of patients requiring surgical intervention, and postoperative outcomes. A meta-analysis of single proportions was conducted to determine the pooled incidence of spinal osteochondromas, incidence of spinal canal-encroaching lesions, and incidence of spinal surgery in HMO patients. Of 415 eligible articles, seven met inclusion criteria. These studies included 198 HMO patients with a weighted mean age of 12 ± 1.0 years, and 47% were female. MRI was the primary imaging modality (99%) with 69% imaged secondary to institutional screening protocols. Approximately 21% had neurological symptoms at the time of imaging. Overall, the pooled incidence of spinal osteochondromas was 36% (Figure 1, 95% CI, 24–51%). Of these, 43% were located in the cervical spine, 38% in the thoracic spine, and 19% in the lumbar spine. Among HMO patients with spinal osteochondromas, 49% (95% CI, 37–61%) had canal-encroaching lesions and 21% (95% CI, 13–33%) underwent spinal surgery. Postoperatively, 47% of individuals had resolution of their symptoms, and no long-term complications were reported across six of the studies. Figure 1. Forest plot of incidence of spinal osteochondromas in HMO patients, demonstrating a rate of 36%. While spinal osteochondromas are prevalent amongst HMO patients, standardised screening protocols remain limited. Despite favourable surgical outcomes for symptomatic canal-encroaching lesions, initial and serial screening is needed to prevent irreversible neurological damage. Early baseline screening may also be warranted for asymptomatic HMO patients once sedation is no longer indicated. As global guidelines evolve, large multicentre prospective studies are needed to identify optimal timing for spinal osteochondroma screening in HMO patients. For any figures or tables, please contact the authors directly.
Legler et al. (Wed,) studied this question.