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972 - Misleading Presentation of Thoracic Ependymoma: The Critical Role of Comprehensive Imaging in Chronic Back Pain Evaluation

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

EA

Eduardo Acevedo-Rosario, MD

Resident Physician
Memorial Healthcare System
Fort Lauderdale, Florida, United States

Co-Author(s)

JM

John Paul Mauriello, DO

Resident Physician
Memorial Healthcare System
Dania Beach, Florida, United States

Corresponding Author(s)

RK

Robert Klecz, MD

Physiatrist
Memorial Healthcare System
Hollywood, Florida, United States

Case Diagnosis: Thoracic Spine Ependymoma Status Post T8-T9 Laminectomies and Tumor Debulking

Case Description: 51-year-old female with a four-year history of low back pain with gradual development of bilateral lower extremity weakness, dysesthesia, and radiculopathy. She had multiple MRIs of the cervical and lumbar spine between 2020-2024. She had been managed by a pain specialist for lumbar spondylosis and radiculopathy with persistent symptoms despite oral analgesics, therapy, medial branch blocks or epidural injections. Neurological examination notable for mild left hip flexion weakness, hypoesthesia in lower limbs, hyperreflexia throughout, length dependent sensory loss to temperature in both lower limbs and ataxic gait. This prompted imaging of the entire spine including thoracic MRI, which revealed a 2.2cm enhancing intramedullary lesion at T8 with hyperintensity extending from C6-C7 to T9. Patient ultimately underwent T8-T9 laminectomies and tumor debulking with biopsy confirmed WHO Grade 2 ependymoma. Postoperatively, she experienced significant relief of her low back pain and improvement in her gait.

Discussions: Ependymomas are rare spinal cord tumors, with an incidence of 0.29 to 0.60 per 100,000 people. Although the cervical spine is the most common site, thoracic involvement, as seen in this case, is less frequent (26%). Thoracic ependymomas can mimic lumbar spine pathologies due to overlapping symptoms like generalized back pain and radicular pain. This case highlights the potential for diagnostic delays when thoracic lesions are mistaken for more common lumbar conditions. Early detection through comprehensive imaging is crucial, particularly when progressive neurological deficits are present.

Conclusions: This case emphasizes the importance of expanding imaging beyond the lumbar spine in cases of chronic back pain with neurological symptoms. Accurate and timely diagnosis of thoracic spinal lesions like ependymomas is essential to prevent further neurological decline and improve patient outcomes.