Regression of a ventral epidural mass after posterior stabilization for cervical spinal metastasis: illustrative case.

BACKGROUND

Epidural masses in patients with metastatic spinal cord compression are generally interpreted as direct tumor extension into the spinal canal. However, not all such lesions necessarily represent fixed tumor tissue. Regression of a ventral epidural mass after stabilization alone in cervical spinal metastasis is rarely described.

OBSERVATIONS: An 82-year-old man presented with tetraparesis after a fall, preceded by weeks of gait unsteadiness and repeated falls. Imaging revealed a destructive C7 lesion with a ventral epidural mass causing severe spinal cord compression. Systemic evaluation suggested metastatic prostate cancer, with prostatic enlargement, a rib lesion suspicious for metastasis, and a serum prostate-specific antigen level greater than 10,000 ng/mL. Because of mechanical instability and cord compression, the patient underwent C4-6 laminectomy and posterior instrumented fixation from C4 to T2. Histopathological examination of tissue obtained from the right C7 pedicle during surgery confirmed metastatic prostate adenocarcinoma. MRI obtained 1 month after surgery demonstrated complete spontaneous resolution of the ventral epidural mass despite the absence of prior systemic therapy.

LESSONS: Not all epidural compressive lesions associated with cervical spinal metastasis necessarily represent progressive tumor extension alone. In patients with marked instability, a component of the lesion may be mechanically reversible and regress after stabilization. https://thejns.org/doi/10.3171/CASE26340.