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Pain and Spine Medicine

A Rare Case of Spinal Perineural Tumor Spread into the Brachial Plexus: A Case Report

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks
Has Audio

    Primary Author(s)

  • Pawan Pathagamage, Other (he/him/his)

    Medical Student
    University of Miami Miller School of Medicine
    Miami, Florida

    • Poster Presenter(s)

  • LH

    Lillian Hubbard, Other

    Medical Student
    University of Miami Miller School of Medicine
    Miami, Florida

    • Primary Author(s)

  • DW

    Daniel Wang, DO

    Resident Physician
    University of Miami/Jackson Health System PM&R Program
    Gaithersburg, Maryland

    • Co-Author(s)

  • Diana Molinares-Mejia, MD

    Cancer Rehabil Director. Residency Program Director
    University of Miami/Jackson Health System PM&R Program
    Miami, Florida

Disclosure(s):
Pawan Pathagamage, Other: No financial relationships to disclose
Diana Molinares-Mejia, MD: No financial relationships to disclose
Case Diagnosis: A 73-year-old male with a history of basal cell carcinoma invading the left brachial plexus, requiring left arm amputation and acute inpatient rehabilitation due to progressive bilateral lower extremity weakness.

Case Description or Program Description: A 73-year-old male with prior basal cell carcinoma resection was admitted for worsening gait instability and neurological deficits. The patient was found to have an enlarging mass at the C6-T1 spinal level, causing severe spinal canal stenosis and cord compression, which required C5-T1 laminectomy, tumor resection, and posterior C5-T2 fusion.

Setting: Acute inpatient rehabilitation

Assessment/Results: Upon completing inpatient rehabilitation, patient showed functional improvements in self-care activities, including eating, hygiene, and dressing, progressing from total/moderate assistance to minimal assistance. Mobility and transfers also improved, with the most significant progress in wheelchair mobility. At discharge, the patient was independent for wheelchair mobility up to 150 feet.

Discussion (relevance): The literature indicates perineural tumor spread to the brachial plexus is rare, with few cases reported in 15 years and often a poor prognosis. Similarly, malignant peripheral nerve sheath tumors (MPNSTs) of the brachial plexus are rare, with an incidence of 0.001%.[1-2] As a result, the inpatient rehabilitation needs of patients with spinal tumor invasion into the brachial plexus are not well-documented. Studies primarily focus on clinical presentations, diagnostic challenges, and clinical outcomes. For example, the study by Donaldson et al. discussed the management and outcomes of MPNSTs but did not provide specific data on their inpatient rehabilitation needs.[2]. Despite the poor medical prognosis these patients face, this case highlights the benefits of inpatient rehabilitation in improving independence and function in this patient population.

Conclusions: Spinal tumor invasion into the brachial plexus is rare, with limited data on this population's functional impairments and rehabilitation needs, creating challenges in management. However, this case shows that proper rehabilitation in these patients can result in functional improvements post-surgical intervention.