Disclosures: Courtney L. Gilbert, MD: No financial relationships or conflicts of interest

Case Description: Primary spinal epidural lymphoma

Setting: Hospital and Rehabilitation Facility

Patient: A 57-year old female presented with six months of lower back pain, weight loss, and one month of progressively worsening bilateral lower extremity numbness and weakness. Assessment/

Results: She underwent surgical resection of the epidural mass, T8-T11 laminectomy and fusion, and biopsy showing diffuse large B-cell lymphoma (DLBCL). Following inpatient rehabilitation, she achieved modified independence with activities of daily living and powered mobility. After discharge, she was started on chemotherapy.

Discussion: Early evaluation showed 0/5 strength in all muscle groups of the bilateral lower extremities and lower extremity hyperreflexia. Sensory level for light touch and pin prick was T8. Rectal exam showed no deep anal pressure or voluntary anal contraction. Magnetic resonance imaging showed a thoracic contrast-enhancing epidural mass with significant mass effect and cord compression. DLBCL is the most common type of non-Hodgkin lymphoma (NHL) and in rare instances occurs as primary spinal epidural lymphoma (PSEL). Spinal cord compression is an uncommon initial manifestation of NHL, occurring in less than 5% of newly diagnosed cases. This type of primary central nervous system lymphoma presents with two stages of clinical symptoms. The first (“prodromal”) stage includes back pain lasting up to one year. The second (“progressive”) stage involves spinal cord compression with neurological deficits developing within 2-8 weeks. Classic B symptoms usually do not develop until later stages, making initial diagnosis challenging. Surgical decompression is often needed to prevent irreversible neurological deficits. DLBCL is sensitive to chemotherapy and radiotherapy, making early detection and diagnosis critical to improving survival and functional outcome.

Conclusion: PSEL often presents with an initial stage of back pain followed by a stage of rapid neurological decline. Prompt imaging and mass biopsy are important steps in diagnosis. Patients with PSEL benefit from inpatient rehabilitation to achieve the highest level of functional independence possible.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/primary-spinal-epidural-lymphoma-presenting-as-acute-cord-compression-a-case-report/