Pediatric C1 Posterior Arch Osteochondroma Presenting as Fever of Unknown Origin and Dizziness WithoutClinical Myelopathy: A Case Report

The human spine is a remarkable structure, a flexible column of bones that protects the delicate spinal cord running from the base of the brain down through the neck and back. At the very top of this column, just beneath the skull, sits a ring-shaped bone called the first cervical vertebra, or C1. This bone acts as a pivot, allowing the head to turn and nod. Because this area is so critical, any abnormal growth or pressure here can have serious consequences. Usually, when a tumor or bony growth presses on the spinal cord in the neck, the body sends clear warning signals: weakness in the arms or legs, numbness, or difficulty walking. These are known as signs of myelopathy, or spinal cord compression. However, the body's reaction to pressure is not always so straightforward. Sometimes, the nervous system reacts in ways that seem unrelated to the spine, causing symptoms like dizziness or even a persistent fever that doctors cannot explain with standard tests. This is the puzzle that a team of neurosurgeons in Jordan recently set out to solve.

In a case report published in April 2026, doctors from Al-Bashir Hospital described the story of a thirteen-year-old girl who had been suffering for six months with a high fever and severe dizziness. She had visited many doctors and undergone countless tests to find the source of her illness, but every result came back normal. Her blood work showed no infection, and her organs appeared healthy. Yet, the fever and dizziness persisted, leaving her family and medical team frustrated. When she finally saw a neurosurgeon, a physical exam revealed something surprising: despite her long list of symptoms, she showed no classic signs of spinal cord damage. She could move her limbs normally, had no loss of sensation, and walked without stumbling. To the untrained eye, she appeared neurologically intact, which made the cause of her illness even more mysterious.

The breakthrough came when the medical team looked inside her neck using advanced imaging scans. A computerized tomography scan and an magnetic resonance imaging scan revealed a large, hard bony growth on the back part of the C1 ring, on the right side. This growth was an osteochondroma, a benign tumor made of bone and cartilage that had formed on the surface of the bone. Although the girl showed no physical signs of weakness, the images told a different story. The tumor was pushing hard against the spinal cord, squashing it significantly and forcing it to the left side. The scans even showed a bright signal on the MRI, a clear sign that the spinal cord tissue itself was under stress and beginning to change, a condition known as radiological myelopathy. The doctors realized that while the girl's body had not yet failed, the pressure on her spinal cord was severe and dangerous.

The medical team decided to operate, not because the girl was paralyzed, but because the images showed a high risk of future catastrophe. They chose a specific type of surgery called a motion-preserving hemilaminectomy. In plain terms, this meant they carefully removed only the right half of the bony arch where the tumor was growing, rather than removing the entire ring or fusing the bones together. This approach was designed to take the pressure off the spinal cord while allowing the young patient to keep her neck flexible as she continued to grow. The surgery was performed with constant electronic monitoring of the spinal cord to ensure it remained safe throughout the procedure. Once the bony block was removed, the spinal cord was free to return to its normal position, and the tumor was taken out completely.

The results were immediate and striking. Following the surgery, the patient's fever and dizziness disappeared completely. She returned to her normal physical activities without any lingering symptoms. A follow-up scan confirmed that the spinal canal was wide open and the neural elements were no longer compressed. The tissue removed during surgery was examined under a microscope, confirming it was indeed a benign growth made of mature bone and cartilage, consistent with an osteochondroma. The doctors noted that the rapid resolution of her fever and dizziness after the pressure was relieved suggested a possible link between the high spinal cord compression and her systemic symptoms. They proposed that the pressure might have disrupted the autonomic nervous system, which controls body temperature and balance, though they acknowledged that this connection is still a hypothesis that needs more study.

This case serves as a reminder that the body's warning signals are not always what they seem. In children, the spinal cord can sometimes compensate for severe pressure without showing obvious physical weakness, hiding the true danger until it is too late. The doctors concluded that when a child presents with unexplained, persistent fever and dizziness, especially when accompanied by other neurological complaints, it is vital to look beyond the usual causes and consider the possibility of a problem at the very top of the spine. By identifying the issue early and performing a targeted surgery that preserves movement, the team was able to resolve a complex medical mystery and prevent a potential tragedy, offering a clear path to recovery for a young patient who had suffered for months without a diagnosis.