Cervical Schwannoma camouflaged by cervical intervertebral disc prolapse-A case report.

INTRODUCTION: Cervical prolapsed intervertebral disc is one of the common conditions causing cervical myeloradiculopathy. Anterior Cervical Discectomy and Fusion (ACDF) is the standard line of management for the same. Intradural neurogenic origin tumors are relatively rare and can present with features of myeloradiculopathy. Radiological imaging plays important role in diagnosis of such pathologies. CASE REPORT: We report a patient with C5-6 cervical disc prolapse that presented with radiculopathy symptoms in the right upper limb, which was refractory to conservative care. He underwent a C5-6 ACDF and reported complete relief from symptoms at 4 weeks. He developed deteriorating symptoms over the next 10 weeks and presented at 14 weeks follow-up with severe myeloradiculopathy symptoms on the left upper limb with upper limb weakness. A fresh MRI identified an intradural extramedullary tumor with cystic changes at the index surgery level. This was treated with tumor excision and histopathology confirmed a diagnosis of schwannoma. Simultaneous presence of cord signal changes with disc herniation obscured the cystic schwannoma which became apparent later on contrast enhanced MRI imaging. CONCLUSION: Careful review of preoperative imaging and contrast MRI study may help in diagnosing cystic schwannomas with concomitant cervical disc herniations that have cord signal changes.

O-arm Navigated en bloc Excision of a Solitary Subaxial Cervical Osteochondroma Presenting as Myelo-radiculopathy: A Case Report.

Introduction: Vertebral osteochondroma is a rare entity. It presents with varied complaints ranging from palpable mass to myeloradiculopathy. En bloc excision is the gold standard treatment option for symptomatic patients. Real-time intraoperative navigation has increased the accuracy and safety of tumor excision. We report a case of cervical subaxial osteochondroma with myelo-radiculopathy, treated with excision, and monosegmental fusion under O-arm-based real-time navigation. Case Report: A 32-year-old male presented with complaints of axial neck pain with the right upper limb radiculopathy for 18 months. On examination, signs of myelopathy were identified without sensory-motor deficit. Magnetic resonance imaging and computed tomography scans were suggestive of solitary C6 osteochondroma compressing spinalcord. O-arm navigated en-bloc tumor excision with C5 hemilaminectomy and monosegmental fusion was done. Conclusion: The use of O-arm navigation aids in accurate intraoperative en bloc excision without any residual tumor and with better safety.