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Spinal Epidural Metastasis

Brian P. Walcott, MD; Jeffrey R. Jaglowski, MD; William T. Curry Jr, MD
Arch Neurol. 2010;67(3):358-359. doi:10.1001/archneurol.2010.7.
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A 74-year-old woman with a history of total thyroidectomy and 5 subsequent neck dissections for papillary thyroid carcinoma presented to the emergency department with pneumonia and back pain. She had computed tomography that revealed a large epidural mass involving the T5 vertebral body and left pedicle with significant displacement of the thoracic spinal cord (Figure 1). She did not have any neurological deficits. Fine-needle aspiration biopsy was performed and confirmed the presence of metastatic papillary thyroid carcinoma. She had resection of the T5 vertebral body, T4-T6 laminectomies, T4-T6 anterior interbody fusion, and T3-T7 instrumented posterolateral spinal fusion (Figure 2). Postoperatively, the patient was neurologically intact. She later had radiation therapy. Routine examination 3 and 6 months following surgery demonstrated normal neurological function.

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Figure 1.

Axial (A), coronal (B), and sagittal (C) computed tomography revealed a large epidural mass (arrow) involving the T5 vertebral body.

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Figure 2.

Postoperative computed tomographic scan (3-dimensional reconstruction) following decompression and mechanical stabilization. An immediate decompression of the spinal cord was achieved; furthermore, the spine was reconstructed during the operation, providing stabilization.

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