Disclosures: Corey Spector, DO: No financial relationships or conflicts of interest

Case Diagnosis: Spinal cord injury following ependymoma removal

Case Description or Program Description: A 54-year-old male was transferred to acute rehabilitation with lower extremity weakness following T8-T10 laminectomy revision surgery with ependymoma resection. Of note, he had an initial back surgery for unknown etiology in Honduras three years prior. He presented to the hospital with one month of progressive bilateral lower extremity weakness, with workup revealing a T9 ependymoma. He previously ambulated independently, but required a single axis cane at presentation due to weakness.

Setting: Tertiary-care teaching hospital

Assessment/Results: He underwent laminectomy with tumor resection, with his post-op course complicated by complete loss of motor and sensory function in his bilateral lower extremities, as well as urinary retention and stool incontinence. On admission to the acute rehab floor, he required maximum assistance for bed mobility and transfers. He was trialed on an oral decadron taper. He was placed on a bowel regimen with alterations until a regimen of metamucil twice daily produced daily formed stools. He was trained to perform self straight catheterizations. By discharge, he stooled regularly and voided independently with straight catheterizations. He performed bed mobility with minimal assistance and transferred with moderate assistance and a sliding board.

Discussion (relevance): Ependymomas are intradural intramedullary glial cell tumors of the spinal cord. Presentation includes localized pain for months to years prior to onset of neurologic symptoms including lower extremity spasticity, loss of pain, temperature, vibration, and light touch sensation. Diagnosis involves intense enhancement on MRI. Management involves surgical resection, with no proven role for chemotherapy. Laminectomy involves removal of part or all of one or both lamina of the vertebra, and allows access for tumor removal. Risks of spinal cord tumors include spinal cord injury.

Conclusions: Our patient unfortunately suffered a spinal cord injury following surgical removal of his ependymoma. Following an acute rehabilitation course, he experienced functional improvements.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-case-of-spinal-cord-injury-following-surgical-ependymoma-removal/