T1 vertebral metastasis treated with corpectomy

Case contributed by Jeremy Caruana

Presentation

Referred with right-sided painful paresthesia in C6, C7 and T1 distributions and interscapular pain disturbing sleep at night .

Patient Data

Age: 45 years
Gender: Male

A predominantly sclerotic lesion involving the posterior two-thirds of the T1 vertebral body with evidence of cortical destruction posteriorly body can be seen. 

Also noticeable in the upper lobes of the lungs are multiple pulmonary metastatic deposits.

A lesion can be appreciated in the T1 vertebral body. It is expanded in size in the posterior aspect, causing mild thecal compression.

Post-op xrays

x_ray

The expandable metal cage and overlying plate at the level of C7-T2 inserted during the T1 corpectomy can be seen.

The expandable metal cage and overlying plate and screws inserted during the T1 corpectomy are visible at the level of C7-T2. 

The metallic expandable cage and overlying plate with screws can be clearly seen at the level of C7-T2.

Multiple pulmonary metastasis can be seen in the upper lung regions.

Case Discussion

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.

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