Sudden post traumatic sciatica caused by a thoracic spinal meningioma

Sciatica, often characterized by pain radiating along the sciatic nerve down the legs, is typically associated with lumbar spine issues. However, a less common cause, which often goes unrecognized, is the presence of a thoracic spinal meningioma—a type of benign tumor. These tumors are slow-growing and are often asymptomatic for extended periods, but in rare cases, they can manifest abruptly, particularly after a traumatic event. This page provides an in-depth overview of sciatica caused by thoracic spinal meningiomas and offers insights for patients who may be dealing with this rare condition.

What is a Spinal Meningioma?

A meningioma is a tumor that arises from the meninges, the membranes that cover the brain and spinal cord. Spinal meningiomas are benign and typically slow-growing, commonly found in the thoracic region of the spine. They are more prevalent in women and older adults, often taking years to become symptomatic. Spinal meningiomas can cause compression of the spinal cord or nerve roots, leading to pain, weakness, and other neurological deficits.

In the case discussed, a 35-year-old woman experienced sudden and intense right sciatica following a fall. This rapid onset of symptoms was due to a previously undiagnosed thoracic meningioma that had displaced the spinal cord. The trauma caused stretching of the already compressed nerves, leading to sciatica and weakness in the leg. This case is rare, as spinal meningiomas typically present with slowly progressing symptoms over a long period.

Symptoms of Thoracic Spinal Meningioma-Related Sciatica

Patients with spinal meningiomas usually experience localized back pain as the initial symptom. As the tumor grows, it can compress the nerve roots, leading to radicular pain (pain that radiates along the nerve), similar to sciatica. When the meningioma is located in the thoracic spine, the pain may not immediately be associated with sciatica, which is typically linked to lumbar spine issues.

In rare cases, as illustrated by the case report, sciatica can manifest suddenly after trauma. The symptoms can include:

• Intense lower back pain radiating to the legs
• Weakness or difficulty in walking or standing
• Numbness or tingling in the legs or feet
• Reflex abnormalities (e.g., increased knee and ankle reflexes)
• Positive Babinski sign, indicating neurological involvement

If you experience sudden sciatica-like symptoms, especially after trauma, and a lumbar MRI appears normal, it is essential to consider the possibility of a thoracic spinal meningioma, particularly if neurological signs are present.

Diagnosis of Thoracic Spinal Meningioma

In cases where sudden sciatica occurs without an obvious lumbar cause, further imaging of the thoracic spine is necessary. MRI is the most reliable tool for diagnosing spinal meningiomas. It can reveal the presence of a tumor compressing the spinal cord or nerve roots and show the extent of displacement caused by the tumor.

In the case presented, the patient’s lumbar MRI was negative, but an MRI of the thoracic spine revealed a T11 meningioma in the left postero-lateral compartment of the spinal canal. The tumor had displaced the spinal cord to the contralateral side, causing compression and the subsequent neurological symptoms.

Treatment and Prognosis

The primary treatment for spinal meningiomas is surgical removal. Given the slow-growing nature of these tumors, surgery often leads to rapid relief of symptoms and excellent long-term outcomes.

In the case report, the patient underwent a T11–T12 laminectomy, during which the tumor was removed. After surgery, the patient experienced significant relief from her sciatica and regained strength in her leg. Physiotherapy played a crucial role in helping the patient recover mobility and return to normal activities.

Postoperative imaging showed no residual tumor or cord compression, and the patient remained symptom-free five months after surgery.

For most patients with thoracic spinal meningiomas, surgery is curative, and the risk of recurrence is low. Regular follow-up with imaging may be recommended to ensure that the tumor does not return.

Understanding the Link Between Trauma and Thoracic Spinal Meningiomas

One of the most unusual aspects of this case is the role of trauma in triggering the sudden onset of symptoms. Thoracic spinal meningiomas are typically asymptomatic for years, with symptoms only appearing when the tumor has grown large enough to compress the spinal cord or nerve roots.

However, in rare cases, trauma—such as a fall or sudden impact—can cause rapid stretching of the spinal cord and nerve roots, leading to acute symptoms. In the case of the 35-year-old woman, the impact on her left foot transmitted force to the spine, stretching the already compressed nerves and triggering sciatica and leg weakness.

It is essential for healthcare providers to recognize this connection between trauma and spinal meningiomas. When patients present with sudden sciatica following trauma, and the lumbar spine appears normal, further investigation of the thoracic spine is warranted.

Key Takeaways for Patients

1. Thoracic spinal meningiomas are rare but treatable causes of sciatica. If you experience sudden sciatica-like pain following a fall or injury, and your lumbar MRI does not show any abnormalities, it may be necessary to investigate further, particularly the thoracic spine.
2. Symptoms can include intense lower back pain, leg weakness, and abnormal reflexes. While sciatica is typically associated with lumbar issues, a thorough neurological examination is critical in identifying the true source of the problem.
3. MRI is the gold standard for diagnosing spinal meningiomas. If your symptoms are unexplained by initial imaging, a thoracic spine MRI may reveal the presence of a tumor causing nerve compression.
4. Surgical treatment is often highly successful. Spinal meningiomas, while rare, can be surgically removed, providing significant symptom relief and preventing long-term neurological damage.
5. Trauma can trigger the sudden onset of symptoms. If you have been symptom-free but experience sudden sciatica after an injury, consider the possibility of a spinal meningioma, especially if the lumbar spine is clear.

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