The ossification of the ligamentum flavum (OLF) is a rare cause of thoracic myelopathy (TM) and most often occurs among East Asian countries such as Japan, Korea, and China. It is rare in other ethnic groups and in individuals below the age of 50 years. It is most often described at the lower thoracic level, being uncommon in the lumbar region and rare in the cervical region. Here, we present the case of a 48-year-old male patient who came to medical attention with a 2-month history of paresthesia of the lower limbs and progressive difficulty in walking. The clinical profile, together with computed tomography and nuclear magnetic resonance imaging of the spine, led to a diagnosis of compressive TM due to OLF in the thoracic spine. The patient underwent endoscopic over-the-top dorsal decompression and resection of the affected ligamentum flavum, without any intraoperative complications. After surgery, the patient had progressed favorably, having no sensory complaints and again becoming ambulatory.
Limited dorsal myeloschisis (LDM) is a rare form of spinal dysraphism characterized by two constant features: a focal “closed” midline skin defect and a fibro-neural tract connecting the skin lesion to the underlying spinal cord. Excision of the tract followed by reconstruction is the preferred management. Intraoperative neurophysiologic monitoring (IONM) is widely used in neurosurgery to recognize important neurological structures but can be challenging in the pediatric population due to incomplete neural development. A 7-day-old male baby presented with a history of dorsal “cigarette burn” skin lesion noted at birth. Clinical assessment and imaging findings revealed a fibro-neural tract extending from the skin surface into the lumbar spinal canal at the level of L5-S1. Excision of skin lesion/tract and untethering of filum terminale with dural tube reconstruction under Intraoperative neurophysiological monitoring (IONM) was performed. The procedure went smoothly. Postoperatively, the child showed no neurological compromise or dermatological complications. In addition, the wound healed well, and the neonate was completely normal. This case demonstrates the successful management of LDM through an IONM-guided complex reconstruction surgery in a neonate and the effective use of IONM in such challenging cases.
Neuroenteric cysts (NCs) of the spinal cord are rare benign tumors which can progressively lead to cord compression and associated features such as parasthesia, weakness, and paralysis. The below-mentioned case discusses about a 39-year-old female patient with NC at the level of C6, C7, and D1 diagnosed on magnetic resonance imaging, followed by surgical excision of the tumor. Histopathology reports suggested NC. Following the surgery, the patient showed significant improvement in neurological symptoms within a week. This case report emphasizes on the importance of clinical examination, radiological examination, and surgical management with appropriate follow-up for NC.
Large intraspinal tumor with significant extra-spinal extension is rare entities, posing considerable surgical challenges. This was the case of an exceptionally large lumbar intraspinal tumor with retroperitoneal extension, highlighting the surgical management and favorable patient outcome. A 56-year-old female presented with lower back pain. Clinical examination revealed no focal neurological deficit or peripheral neurovascular deficits. Imaging revealed an extensive lumbar intraspinal tumor extending into the retroperitoneal space, measuring approximately 14 cm × 15 cm × 18 cm. The tumor occupied the spinal canal from D12 to L2 and extended laterally and anteriorly into the retroperitoneum, compressing adjacent structures. The patient underwent a complex surgical procedure involving collaboration between neurosurgeon, cardiothoracic surgeon, and urosurgeon. Gross total resection of the tumor was achieved. Histopathological analysis revealed Grade 1 schwannoma. Postoperatively, the patient experienced significant relief of preoperative symptoms. Importantly, there was no evidence of new neurological deficits or power loss. The patient was discharged home and has remained neurologically intact at follow-up. The surgical approach should be carefully planned to minimize the complications and achieve complete tumor removal. Postoperative care and long-term follow-up are crucial to ensure favorable outcomes and prevent recurrence.
