Working Diagnosis:
Large Thoracic Spinal Cord Ependymoma

Treatment:
She underwent T8-T11 thoracic laminectomy and tumor resection. She was then admitted to the inpatient spine rehabilitation service for physical and occupational therapy for 10 days.

Outcome:
She improved her left leg strength post-operatively while on the rehabilitation unit, but her left leg continued to lack coordination while both the electric shock sensations and back pain resolved. She continued with physical and occupational therapy multiple times weekly to improve her left leg coordination. She continued to advance in her home exercise program as she works both inside and outside of the scheduled therapy sessions. She is hopeful that she may be able to progress enough to resume her previous active lifestyle, especially downhill skiing.

Editor's Comments:
Ependymomas are the most common intramedullary spinal cord tumors in adults, with peak age of presentation between 30 and 40 years. These are intramedullary tumors that typically begin centrally in the cord, expanding symmetrically as they grow. The typical presentation is localized pain for months to years preceding neurologic deficits such as lower extremity spasticity, paresthesia, sensory loss, and gait ataxia. MRI is helpful for diagnosis and treatment is mainly gross total resection. It is important to maintain a high index of suspicion when evaluating patients with back discomfort and look for red flag signs and symptoms, such as the neurologic deficits and upper motor signs present in this patient, that would warrant further work up with advanced imaging and referral.

References:
WHO Classification of Tumours of the Central Nervous System, 4th ed, Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (Eds), IARC, Lyon 2016.

Intrinsic spinal cord tumors. In: Handbook of Clinical Neurology, Amsterdam 1997. Vol 24, p.497.

Celano E, Salehani A, Malcolm JG, Reinertsen E, Hadjipanayis CG. Spinal cord ependymoma: a review of the literature and case series of ten patients. J Neurooncol. 2016;128(3):377-86.

Salari F, Golpayegani M, Sadeghi-Naini M, Hanaei S, Shokraneh F, Ahmadi A, et al. Complete Versus Incomplete Surgical Resection in Intramedullary Ependymomas: A Systematic Review and Meta-analysis. Global Spine J. 2021;11(5):761-73.

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