Differential diagnosis and management of subaxial cervical chondroma: illustrative case.

backgroundPeriosteal chondromas are rare benign cartilaginous tumors that rarely arise in the spine, with cervical localization being exceptionally uncommon. Most of reported cases of cervical chondroma involve younger patients and are often diagnosed in the upper cervical region (C1-2). The authors present the case of a 65-year-old woman with a history of metastatic breast cancer undergoing routine PET-CT, which revealed a hypermetabolic osteodestructive lesion at C6. MRI findings suggested spinal metastasis with myeloradicular compression. OBSERVATIONS: Surgery was performed via anterior cervical corpectomy and arthrodesis using a carbon fiber cage to minimize postoperative MRI artifacts and optimize radiotherapy. Gross-total resection was achieved with no neurological complications. Follow-up imaging confirmed adequate decompression and cervical spine stability. Histopathological examination surprisingly showed a periosteal chondroma. LESSONS: Cervical chondromas are rare and can be misdiagnosed as metastatic lesions especially in older patients with previous history of cancer, emphasizing the need for histopathological diagnosis. Carbon fiber implants offer advantages for postoperative imaging and radiotherapy planning, if needed. Further research is warranted to explore potential genetic or syndromic links in oncological patients with atypical spinal chondromas. https://thejns.org/doi/10.3171/CASE25303.