Spinal Cord Injury due to the Giant Cell Tumor of the Second Thoracic Vertebra: A Case Report
A 16-year-old female presented with a 3-month history of progressive upper back pain. She showed a visual analogue scale result of 50 mm, with the pain being worse in the supine position at night. On the first visit, she was treated with a conservative management. However, the pain did not subside and a sudden weakness of the lower extremities developed after 5 days. She reported a radicular pain along the T1 dermatome and hypoesthesia below the T1 dermatome, along with constipation. This patient's neurologic classification according to the American Spinal Injury Association (ASIA) International Standards for the neurological classification of the Spinal Cord Injury (SCI) is as follow: sensory and motor level of injury, T1 bilaterally; and degree of completeness, ASIA Impairment Scale (AIS) grade D. She demonstrated 3+reflexes at the both patellas and ankles and a positive Babinski sign. The Modified Ashworth Scale (MAS) was graded as 1. Her strength was generally of a fair grade in the lower extremities. There was tenderness on percussion of the T2 thoracic spine. On the radiographs, there was an osteolytic bony lesion at the T2 vertebra. The magnetic resonance imaging (MRI) revealed a large mass in the T2 vertebral body with the involvement of the left pedicle, transverse process, both lamina and spinous process. In addition, there was high signal intensity in the spinal cord at the T2 level, which suggested compressive myelopathy ().\nAfter the patient was transferred to the department of neurosurgery, she was treated with a tumor resection and laminectomy of the T2 vertebra, with the posterior fixation of T1, T3, and T4 (). On the pathologic report, the large mass was confirmed to be GCT (). To optimize the local disease control, the patient underwent the CyberKnife (Accuracy Inc., Sunnyvale, CA, USA) three times over three days. The postoperative anterior-posterior plain film and the lateral plain films of the thoracic spine revealed a good screw position ().\nSix weeks after the surgery, the patient was transferred to the department of physical medicine and rehabilitation. The radicular pain was subsided, but the mild hypoesthesia from T1 to T3 dermatome remained. She demonstrated no hyperreflexia and fair+ to good strength in the lower extremities. The MAS was graded as 0. A moderate assistance was required for walking and the lower body dressing. The patient was placed in a cervicothoracic orthosis for stabilizing the operative site. She practiced walking with a high walker and a cane later. She was trained in using a dressing stick. The function of the bladder was normal when checked with a bladder chart and the measurement of the residual urine. However, the patient complained of constipation. She was given a high-fiber diet regimen, along with the timed bowel program and the abdominal wall massage. As a result, her constipation subsided. After one month, the patient was able to walk independently, and the impairment scale was changed to AIS E (sensory and motor functions are normal) without any evidence of recurrence (). The patient is now two years out of the surgery and the radiation therapy. She has returned to school as a student, has no significant complaints and remains neurologically intact.