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Sohn, You, Park, and Park: Thoracolumbar Epidural Pannus Causing Paraplegia in Rhematoid Arthritis
Case Report

Journal of the Korean Orthopaedic Association 2015; 50(3): 249-254.

Published online: 30 June 2015

DOI: https://doi.org/10.4055/jkoa.2015.50.3.249

Thoracolumbar Epidural Pannus Causing Paraplegia in Rhematoid Arthritis

Hong Moon Sohn, M.D., Jae Won You, M.D., Sang Soo Park, M.D., Hyung Seok Park, M.D.

Department of Orthopaedic Surgery, Chosun University School of Medicine, Gwangju, Korea.

Correspondence to: Sang Soo Park, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea. TEL: +82-62-220-3147, FAX: +82-62-226-3379, wwwpibak@daum.net

Received 4 September 2014       Revised 23 October 2014       Accepted 1 December 2014

Copyright © 2015 by The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Rheumatoid pannus involvement of the cervical spine like the atlanto-axial instability is common, but rheumatoid pannus involvement of the thoracolumbar spine is very rare. A 70-year-old woman with a 20-year medication history of rheumatoid arthritis (RA) came to a hospital because of paraparesis without trauma. Radiologic examination showed that the mass in the posterior aspect of the spinal canal of T12 to L2 was compressing the spinal cord. She underwent mass removal and posterior decompression. Histologic findings revealed lymphocytes with chronic inflammation which was seen in histologic findings of RA. Therefore, we supposed that the mass was a rheumatoid pannus and that it had caused paraparesis. We report a good result of paraparesis caused by thoracolumbar epidural pannus by RA in a patient who was treated with pannus removal and posterior decompression.

Keywords: epidural pannus, paraparesis, rheumatoid arthritis

Figures and Tables

Figure 1

Plain radiographs examination of the thoracolumbar spine at admission.

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Figure 2

Axial computed tomography scans of the thoracolumbar spine. Calcified mass-like lesion in the posterior aspect of the central spinal canal of T12 to L2 resulted in compression of the spinal cord (arrow).

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Figure 3

Magnetic resonance image. Unenhanced rod-like hyposignal intensity mass in the posterior aspect of the thecal space of T12 to L1 resulted in compression of the spinal cord. (A-C) Sagittal images (circles). (D-F) Axial images (arrows).

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Figure 4

Operative finding: Chalklike materials in the posterior aspect of the spinal cord of T12 to L2.

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Figure 5

Histology finding of epidural mass. (A) In mid power field, eosinophilic bony chips (arrow) and stromal tissue with chronic inflammation are noted (H&E, ×200). (B) In high power field, stromal tissues with chronic inflammatory cells (lymphocytes) are noted (arrow) (H&E, ×400).

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Figure 6

Plain radiographs one year after the operation.

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Notes

This study was supported by research fund from Chosun University Hospital, 2014.

CONFLICTS OF INTEREST The authors have nothing to disclose.

References

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