J Korean Orthop Assoc.  2015 Jun;50(3):249-254. 10.4055/jkoa.2015.50.3.249.

Thoracolumbar Epidural Pannus Causing Paraplegia in Rhematoid Arthritis

• Sohn HM
• You JW
• Park SS
• Park HS

• KMID: 1851959
• DOI: http://doi.org/10.4055/jkoa.2015.50.3.249

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.

Keyword

epidural pannus; paraparesis; rheumatoid arthritis

MeSH Terms

Aged
Arthritis*
Arthritis, Rheumatoid
Decompression
Female
Humans
Inflammation
Lymphocytes
Paraparesis
Paraplegia*
Spinal Canal
Spinal Cord
Spine

Figure

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  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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