Clinical Sciences/Health Conditions
Julie Shatto, BS
Medical Student
University of Alberta
Edmonton, Alberta, Canada
Hardeep Kainth, MD
Associate Clinical Professor
University of Alberta
Edmonton, Alberta, Canada
Acute spinal cord injury (SCI) secondary to compressive spinal metastases
Case Description:
A 62-year-old male presented for total hip arthroplasty after sustaining a closed femoral neck fracture from a ground-level fall. On postoperative day three, he developed paraplegia with complete lower extremity motor loss. This was accompanied by a band-like dysesthesia at T6, complete sensory loss below this level, and neurogenic bowel and bladder symptoms.
Imaging revealed extensive metastatic disease involving the cervical and thoracic spine, with central canal stenosis from T6–T7 through T8–T9. Subsequent biopsy confirmed prostate adenocarcinoma as the primary malignancy. Bone scintigraphy demonstrated widespread osseous metastases predominantly affecting the axial skeleton. The patient declined surgical decompression and was treated with dexamethasone and palliative radiation therapy.
At physiatry assessment ten days following SCI onset, the patient reported gradual neurological improvement, with return of ankle dorsiflexion and plantarflexion followed by knee flexion and extension, and improving lower extremity sensation. Using the ISNCSCI standards, his injury was classified as T6 AIS D.
Discussions: This case represents a rare presentation of acute SCI secondary to previously undiagnosed metastatic disease shortly after non-vertebral orthopedic surgery. While postoperative neurological deterioration has been reported in the context of epidural hematoma or trauma, acute SCI precipitated by metastatic spinal disease in this setting is not well described. We hypothesize that postoperative inflammation may have exacerbated subclinical metastatic lesions, leading to acute cord compression. Retrospectively, this patient’s initial presentation likely represented a fragility fracture in the context of advanced malignancy.
Conclusions: This case highlights the importance of maintaining a high index of suspicion for occult metastatic disease in older adults presenting with low-energy fractures and postoperative neurological decline. Early recognition of malignant spinal cord compression and prompt physiatry involvement are critical for optimizing functional outcomes and rehabilitation planning.
