Spinal Cord Injury Secondary to Neuroblastoma: A Case Report

Case Diagnosis: A 24-year-old female with a history of left paraspinal neuroblastoma diagnosed at age 2 and treated with chemotherapy eventually diagnosed with incomplete spinal cord injury.

Case Description or Program Description: The patient presented to outpatient PM&R clinic in 2021 with persistent lower extremity weakness and gait instability. She could walk about a mile before being limited by pain, and was reliant on compensatory strategies, such as holding onto railings to prevent falls. Bowel and bladder function remained intact. She was primarily managed by her oncology team, who referred her to PM&R for rehabilitation focused on improving strength, mobility, and functional independence. Exam revealed moderate bilateral lower extremity weakness (left > right), increased tone, spasticity, hyperreflexia with bilateral clonus, pes planus, genu valgus, and a spastic diplegic gait. MRI showed symmetric thinning and flattening of the thoracic spinal cord (T3-T6) due to prior neuroblastoma-related mass effect and a T2 hyperintense lesion (T3-T7) consistent with residual quiescent tumor. She also had resultant thoracolumbar scoliosis as a consequence of her disease course.

Setting: Outpatient PM&R clinic at pediatric hospital.

Assessment/Results: Her presentation suggests incomplete spinal cord injury secondary to neuroblastoma. Management has focused on home exercises and outpatient physical therapy to improve strength, optimize gait efficiency, and prevent arthritis. Four years later she continues to walk independently.

Discussion (relevance): This case highlights possible long-term neurological sequela of neuroblastoma and the value of rehabilitation in improving function and mobility in survivors.

Conclusions: Spinal cord involvement can occur in up to 15% of children with neuroblastoma, however, prevalence is most common in those diagnosed under age 2. Long-term disability from neuroblastoma-related spinal cord injury is common, affecting approximately 75% of patients. (Trahair, 2017) This case raises the question of if long-term disability can be avoided with referral to pediatric PM&R physicians and earlier implementation of rehabilitation and physical therapy.