Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: Spine
Abstract number: 24453
CIRCUMFERENTIAL ENCASEMENT OF THE SPINAL CORD IN A PATIENT WITH
RHEUMATOID ARTHRITIS
Saqib JAVED, Veenesh SELVERETANAM, Atik BABORI, Crispin WIGFIELD
Walton Centre for Neurology and Neurosurgery, Liverpool (UNITED KINGDOM)
An 83 year old lady with rheumatoid arthritis (RA) presented with an 8 week history of
progressive bilateral leg weakness and urinary frequency. Her lower limbs were
hypertonic and hyper-reflexic with grade 4/5 power throughout and up going plantar
response bilaterally. Magnetic Resonance Imaging (MRI) of the spine showed an
enhancing circumferential stenosing extradural mass lesion extending from C7 to
T12. She underwent an upper thoracic decompressive hemilaminectomy and
ultrasound assisted biopsy of the extradural lesion followed by a cervico-thoracic
(C6-T3) laminectomy and complete posteror decompression of spinal cord one week
later. Histology showed a chronic inflammatory process with hyalinised fibrosis,
consistent with rheumatoid arthritis. By twelve months she was walking
independently with only a stick for support. Thickening of the ligamenta flava is a
common disorder, but isolated thickening of clinical significance is rare. In our case
MR imaging demonstrated an unusually long extra-axial mass in the spinal canal at
the cervicothoracic junction with only one such case being reported previously
reporting a much shorter lesion. However, we know of no known cases of chronic
hyalinised fibrosis consistent with rheumatoid arthritis involving the cervico-thoracic
junction. Epidural inflammatory lesions should be considered in the differential
diagnosis of RA patients who present with neurologic signs and symptoms referable
to the spinal cord even if involvement of the cervical spine is not apparent with
surgery and histology being essential for a definitive diagnosis. Furthermore, the
value of ultrasound assisted spinal surgery in avoiding complications is illustrated.
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