Neurological Recovery After Complete Paraplegia Due to Metastatic Prostate Cancer: A Case Report.

Loss of motor function due to metastatic epidural spinal cord compression (MESCC) is a time-sensitive oncologic emergency. Rapid recognition and decompression are essential, yet complete paraplegia often portends poor recovery. We report a case of severe MESCC secondary to metastatic prostate adenocarcinoma, complicated by a postoperative epidural hematoma, which achieved near-complete recovery following timely surgical intervention and multidisciplinary management. The patient was a 70-year-old gentleman with newly diagnosed metastatic prostate cancer in the upper thoracic spine, who presented with rapidly progressing bilateral leg weakness evolving to complete paraplegia within 3 days, and displayed a T4 sensory level and incontinence. He underwent emergent laminectomy, decompression, tumor excision, and instrumented fusion. He began regaining voluntary movement by postoperative day one, which further improved over the next few days. On day three, neurological decline prompted a repeat MRI, revealing a postoperative thoracic epidural hematoma, which required evacuation. Following surgery, the patient exhibited good neurological recovery. He was discharged to acute rehab on androgen deprivation therapy. After six weeks, he had regained full strength. This case highlights that meaningful recovery can occur from complete paraplegia secondary to MESCC, provided that timely decompression, stabilization, hemodynamic optimization, and vigilant postoperative monitoring are ensured.