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In our case CT of the lumbar spine exhibited an irregular shaped osseous mass with sclerotic margin that projected from the inner aspect of the exostotic right lamina-facet of L2 into the spinal canal. MRI detected the intermediate intensity core of the tumour��similar to that of bone marrow��surrounded by a ring-like low-intensity area corresponding to ossification, well depicting the level and the extent of neural compression. The lesion was not enhanced by gadolinium. No malignant aspects were seen. Although rarely occurring in the lumbar spine as well as in aged patients, osteochondroma was suspected. Neurological and radiographical features considered, we planned and achieved the total surgical removal to relieve the cord-root compression as well as to prevent recurrence, without considering preoperative biopsy. In fact, the treatment of choice for symptomatic lesions should be the total surgical removal while asymptomatic SOCs can be followed conservatively due to a low rate of malignant transformation. In our case the outcome was favourable. At Tryptophan synthase clinical�Cradiological follow-up the patient is symptoms-free and no signs of recurrence are seen on CT and MRI. Learning points Although osteochondromas (OCs) rarely affect the lumbar spine and cause neurological symptoms, they should be considered in the differential diagnosis to plan the proper therapeutic modality. CT and MRI are the best procedures for detecting the lesion, for assessing the cord-root impairment, and thus for evaluating the therapeutic options. The treatment of choice of symptomatic spinal OCs consist of total surgical removal, if possible, to avoid the risk of recurrence and malignant transformation. Owing to the absence of adhesion between the tumour and the dura, an en bloc removal is generally possible, a piece-meal resection being required for larger lesions. In the surgical strategy, a key point consists of avoiding approaching the lesion through its intraspinal pole in order to reduce the risks of iatrogenic spinal cord compression via surgical instruments. With this aim, the diamond burr drill method is recommended. Generally, the limited extent of artrectomy does not require spinal fusion procedures. Preoperative biopsy could be considered to decide surgical modality if primary malignancy is radiographically suspected. Surgical treatment of symptomatic vertebral OCs allows a favourable outcome in the most cases. Footnotes Contributors: All the authors substantially contributed to the conception and design, acquisition of data or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content and final approval of the version published. Competing interests: None. Patient consent: Obtained.