Diagnostic Dilemmas and Perioperative Challenges in Lumbar Spinal Chondroma: A Narrative Review with Case Presentation.

The occurrence of lumbar spinal chondromas is exceptionally rare, with fewer than 30 cases reported. Due to their rarity and similar presentation to more common spinal pathologies, lumbar spinal chondromas often pose diagnostic challenges. A 19-year-old patient was diagnosed with lumbar spinal chondroma at the L5-S1 level. The tumor was initially misinterpreted as a case of lumbar disc prolapse, and surgical decompression was planned. During surgery, a whitish firm, cartilaginous tumor compressing the S1 nerve root was discovered and excised. A narrative review of the literature was conducted, analyzing case reports and series of lumbar spinal chondromas published between 1900 and October 2025. A total of 25 cases were included, with a focus on clinical presentation, imaging findings, surgical management, and outcomes. The most common symptoms of lumbar spinal chondromas are low back pain (44%) and sciatica (40%). Neurological deficits, such as conus medullaris syndrome, cauda equina syndrome, or paraparesis, were observed in 8% of cases. Lumbar spinal chondromas, although rare, should be considered in the differential diagnosis of lumbar radiculopathy or back pain. In this nearly doubled cohort relative to the prior systematic review, peripheral rim enhancement on magnetic resonance imaging, previously considered the most characteristic discriminating feature, was present in fewer than a third of cases, highlighting the persistent diagnostic difficulty of this entity. The surgical approach and anatomical location significantly influence recovery, with most cases showing positive postsurgical results.