Abstract
RATIONALE: Osteochondroma (OC) is a benign bone tumor commonly found near the ends of long bones. While spinal and hip localizations are rare, bilateral hip involvement is often associated with hereditary multiple exostoses, occurring in 30% to 90% of such cases. This report describes a unique case of bilateral hip OC developing after a spinal cord injury, in the absence of family history or hereditary multiple exostoses. PATIENT CONCERNS: A 35-year-old male presented with painful bilateral hip swelling and restricted mobility following a rural accident that caused a C6-C7 vertebral fracture with bilateral anterior dislocation of the articular facets. He also exhibited spastic tetraplegia and flexion contractures, with signs suggestive of femoral nerve compression. DIAGNOSES: Initial imaging revealed myositis ossificans involving the iliopsoas and spinal muscles. A bone scan identified an immature osteoma. Histopathological examination following surgical excision confirmed the diagnosis of OC. INTERVENTIONS: The patient underwent spinal surgery 2 days after the trauma, followed by admission to a physical medicine rehabilitation unit. Surgical resection of the left hip lesion improved flexion, and a similar procedure on the right hip yielded temporary improvement but led to complications, including infection requiring antibiotics and drainage. OUTCOMES: Despite surgical interventions, tumor recurrence occurred within 3 months. Imaging confirmed recurrent myositis ossificans and fluid collections. One year postinjury, neurological deterioration was noted, with spastic tetraplegia progressing from the C5 to C7 level and worsening lower limb spasticity. Valium was introduced for spasm management. LESSONS: This case highlights a rare occurrence of bilateral hip OC following spinal cord injury and raises important questions about trauma-induced mechanisms in OC pathogenesis. It suggests the need for further investigation into the relationship between spinal trauma, heterotopic ossification, and tumor development.