T1 vertebral metastasis treated with corpectomy
Cutaneous leiomyosarcomas are rare soft-tissue tumors, arising from the arrector pili muscle of the hair follicles1. Corpectomies of the cervical spine are indicated in spinal degenerative disorders, tumors, and ossification of the posterior longitudinal ligament 2, amongst others. In this case, a corpectomy was carried out to remove bony metastasis from a primary, recurrent cutaneous leiomyosarcoma.
This patient was referred from oncologists to neurosurgical care for progressive T1 metastasis (confirmed on repeat imaging) causing impingement on the right T1 nerve root resulting in right-sided paresthesia and interscapular pain. These symptoms were disturbing the patient’s sleep. There was no weakness, no loss of dexterity, no history of falls and no urinary symptoms.
The patient was a known case of metastatic cutaneous leiomyosarcoma in the lower back. He had undergone excision of leiomyosarcoma with subsequent recurrence in the past. A wedge resection of the lung for excision of metastasis had also been carried out.
The patient saw no improvement in the presenting symptoms on being given a course of oral dexamethasone, as well as trials of pregabalin and gabapentin, and hence a T1 corpectomy was performed to prevent further deterioration of symptoms.
He underwent a T1 corpectomy via an anterior approach. A 16mm expandable cage was inserted and a 40 mm plate was fixed with screws over the implant. Intra-operatively, ossification of the posterior longitudinal ligament was noted. Samples from the ligament, together with bony fragments, were sent for histology. Metastatic growth secondary to the known leiomyosarcoma was confirmed from these samples.
The patient recovered well post-operatively and reported an improvement in symptoms, with resolution of the paresthesia and pain.
Special thanks to Mr. Shawn Agius, consultant neurosurgeon and spinal surgeon, who co-authored this case.