Spinal cord compression is an unusual but potentially catastrophic man
ifestation of hereditary multiple exostoses (HMEs). Isolated, osteocho
ndromas are usually of little significance. However, if they are locat
ed near neurologic structures, they may cause irritation due to mechan
ical compression. In patients with HMEs who present with neck or back
pain, and particularly in those who have neurologic symptoms in the up
per or lower extremities, a diagnosis of intracanalicular osteochondro
ma should be presumed until proven otherwise. Prompt diagnosis and sur
gical excision affords the best prognosis for these patients who have
spinal cord compression secondary to intracanalicular osteochondroma.