History: The patient is a 54 year-old man who presented to the outpatient clinic with a four week history of gait ataxia with multiple falls. He also described a constant, progressive pain between his shoulder blades that improved with lying down. His past medical history is significant for hypertension and he is currently taking anti-hypertensive medications. Otherwise he denies any other medical or surgical history. He has smoked 2 packs of cigarettes a day for the past 20 years and denies a family history of cancer.
Physical: Motor examination demonstrated 5/5 strength in his upper and lower extremities. Sensory exam was intact to pin prick and light touch throughout. A non-dermatomal decrease in proprioception and vibration sense was noted in both lower extremities. Reflexes were 2+ in the upper estremities and patellar and achilles reflexes were 3+ bilaterally. Babinski sign was present bilaterally with 2-3 beats of clonus in both ankles. A spastic gait was noted.
Imaging: A MRI of the thoracic spine was obtained.
Figure 1.
Figure 2.
Figure 3.
1. The diagnosis of this lesion is most likely:
2. Thoracic spine x-rays are needed for further evaluation:
3. A thoracic spine CT Scan is needed for further evaluation:
4. A bone scan is needed for further evaluation:
5. A spinal angiogram is needed for further evaluation:
6. The treatment option of choice in this patient is:
7. Your preferred surgical approach for treating this lesion:
8. Adjunctive treatments needed for this patient would be:
9. Please provide any comments or suggestions regarding management of this case:
we must have hystological (may be immunohistological) analysis
Laminectomy would provide immediate deompression of the spinal cord, and access to tissue for histopathology. A posterior stabilisation procedure will be required since the vertebral body is also involved. Depending upon the histopathological diagnosis, endovascular treatment/radiotherapyin case of hemangioma can be planned, while radiotherapy will be needed in case it turns out to be a metastasis.
Probable ABC with high-grade spinal cord compression. Huge flow voids in the tumor Embolization followed by posterior anterior decompression and circumferential fixation should be definitive therapy.