Posterior Extradural Spinal Tumor Extending From T3 to T6 Presenting With Paraplegia

TL;DR

A rare case of a non-cancerous spinal tumor causing paraplegia was successfully treated with surgery and showed partial recovery.

Contribution

This case report highlights the clinical presentation and successful management of a rare fibrolipoma extradural spinal tumor.

Findings

The patient showed neurological improvement post-surgery, regaining partial sensation and sphincter control.

Histopathology confirmed the tumor was a benign fibrolipoma with no malignancy.

The case emphasizes the importance of timely diagnosis and surgical intervention for extradural spinal tumors.

Abstract

Extradural spinal tumors represent a large proportion of all spinal tumors and commonly present with spinal cord or nerve root compression. Although metastatic lesions are the most frequent, benign and less common entities may also occur. Prompt recognition is essential to prevent irreversible neurological compromise. We report the case of a 55-year-old male patient with diabetes mellitus who presented with paraplegia following three months of progressive dorsal pain and lower limb paresthesias. Neurological examination revealed flaccid paralysis of the lower limbs, sensory loss below the T5 dermatome, and sphincter dysfunction. Thoracic spine MRI demonstrated a posterior extradural mass extending from T3 to T6, compressing the spinal cord and associated with hematomyelia. The patient underwent urgent posterior decompression with wide laminectomy, complete tumor resection, and instrumented stabilization using transpedicular screws and titanium rods. Vancomycin powder was applied intraoperatively for infection prophylaxis. Postoperatively, the patient regained superficial sensation in the lower limbs and sphincter control within two months. At six months, neurological function improved to American Spinal Injury Association (ASIA) grade C, with muscle strength graded 3/5 at the hips and knees and 2/5 at the ankles according to the Medical Research Council (MRC) scale, allowing assisted ambulation through intensive physiotherapy. Histopathological examination confirmed a fibrolipoma with secondary ischemic and inflammatory changes and partial bone necrosis, without evidence of malignancy. Reporting such cases contributes to the understanding of the clinical spectrum of extradural spinal tumors and reinforces the need for prompt recognition and intervention.

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