A 63-year-old man came to the Kentucky Spine Institute with worsening paralysis approximately one month after receiving a diagnosis of renal cell carcinoma of L2. He was undergoing radiation treatments at a local institution for pain and weakness in his legs. During the course of the radiation treatments he suddenly became completely paraplegic and was transferred for definitive care.
examination showed that he had no motor or sensory function of his
lower extremities. Perianal sensation and voluntary anal sphincter
control were intact, however.
The patient underwent preoperative A/P and lateral myelography
a and b) and a postmyelogram computed tomography (CT) scan (Figure
2). These tests showed the mass located in and around the L2 vertebral
body and impinging on the cauda equina at this level.
Figure 1, a and b: A/P and lateral myelograms show the complete myelographic block and cauda equina compression caused by the L2 tumor.
Figure 2: Axial postmyelogram CT scan through the L2 vertebral body showing the bony destruction and the compression of the cauda equina at the level of the tumor.
the tumor mass was embolized by the interventional radiologist at
Samaritan Hospital. The patient then underwent an anterior decompression
of the tumor followed by anterior strutting with a titanium interbody
fusion cage. Because of the marked instability of his spine, the
procedure also included a posterior spinal fusion.
After an intermediate hospital course, the patient was transferred to Cardinal Hill Hospital for lower extremity rehabilitation. Immediately after the procedure, he had regained the ability to move his lower extremities, although he did not have antigravity strength or the strength to ambulate at this time. At three-month follow-up, he has regained the ability to walk with the use of a cane.
Radiographs taken three months postoperatively (Figure 3) show the interbody fusion cage and the rods and screws used for the posterior spinal stabilization.
Figure 3: A/P and lateral postoperative radiographs showing screws and interbody fusion cage in their final position.