Thoracic Epidural Lesion

H&P

• HPI:
  • Presented to ED
  • Back pain x1m
  • Intermittent BLEs weakness
  • Denies bowel/bladder issues
• PE: Full strength throughout, SITLT, spastic BLEs, 4+ bilateral Achilles and patellar reflexes, 10+ bilateral clonus

Imaging

Thoracic Spine MRI without Contrast - Sagittal T2WI and STIR

A thoracic lesion at T5-C6 levels.

Thoracic Spine MRI without Contrast - Sagittal T1WI and T2WI

Thoracic Spine MRI without Contrast - Axial T1WI and T2WI

The lesion appears to be extradural.

Thoracic Spine MRI with Contrast - Sagittal T1WI and Axial T1WI

CT Thoracic Spine - Sagittal and Axial

Surgical Intervention

• Prone
• T4-T7 laminectomies
• Epidural lesion resection
• Specimen sent for permanent

Intra-Operative Imaging

Epidural Tumor in Place

Magnified View of the Tumor

Post-Resection

Specimen

Post-Operative Course

• Recovered well from surgery
• No new neurological deficits
• ICU observation overnight
• Transferred to floor on POD1
• Persisted clonus and hyper-reflexia on BLE
• Clonus resolved on POD2
• Physical therapy: inpatient rehabilitation with 3 or more hours of skilled therapy per day
• Pathology report: extraosseous aneurysmal bone cyst

Clinic Follow-Up (3 Weeks)

• Symptoms all improved
• Wound well-healed
• BLE spasticity, hyper-reflexia improved
• Normal gait
• 3 months post-op follow-up thoracic MRI: no residual/recurrence

Discussion

• Pre-op MRI indicated an epidural lesion
• Rib numbers were carefully counted before OR for precise localization
• Optional intraoperative neuro-monitoring