Resident NW Marianjoy Rehabilitation Hospital Westmont, Illinois, United States
Case Diagnosis: Spinal Ependymoma, WHO Grade 2, Status Post Cervical Laminectomy (C1-C3) and Resection of Intramedullary Mass
Case Description: A 57-year-old female with a history of cervical spine cavernous hemangioma, sarcoidosis, and hypothyroidism presented with gait abnormalities and paresthesias. MRI revealed a hemorrhagic intramedullary mass at C2, (1.3 x 1.2 x 1.5 cm) with spinal cord expansion. She underwent posterior cervical laminectomy from C1 to C3 and resection of the mass due to progressive neurological symptoms. Postoperative MRI showed cord edema from C1 to C6. Examination revealed muscle strength of 4/5 to 5/5 below the injury level, and her ISNCSCI classification was C1 AIS D. Initial evaluations by occupational therapy (OT) showed Maximal Assistance for toileting and lower body dressing, Moderate Assistance for showering, and Minimal Assistance for upper body dressing. She ambulated 150 feet with physical therapy (PT) and required minimal assistance for bed mobility, car transfers, and sit-to-stand movements.
Discussions: This case of spinal ependymoma, WHO Grade 2, is a rare intramedullary tumor with relatively mild neurological impairment despite its location. Rehabilitation played a central role in addressing gait instability and fine motor deficits. A structured program of PT and OT aimed to restore motor function and promote neuroplasticity. Intramedullary tumors are associated with longer operation times, extended hospital stays, and worsening of activities of daily living (ADLs) at discharge, contributing to significantly higher medical costs. Despite these challenges, data on intramedullary tumor outcomes remain limited, particularly regarding rehabilitation efficacy and recovery trajectories, highlighting the need for further research to optimize care.
Conclusions: Rehabilitation following intramedullary tumor resection is crucial for maximizing functional outcomes and independence. Prompt surgical intervention, combined with targeted rehabilitation, can help patients regain motor function despite neurological impairments. Managing postoperative challenges, including neurogenic bladder and sensory changes, remains critical to achieving optimal outcomes.
