Acute spinal cord compression in the setting of chronic extramedullary hematopoiesis of the thoracic spine

BACKGROUND: Though rare, pathologic extramedullary hematopoiesis (EMH) can occur in response to myeloproliferative disorders and may present as paravertebral masses. CASE DESCRIPTION: We describe a 63-year-old female with unspecified thalassemia, hemochromatosis, and known asymptomatic extramedullary hematopoiesis of the thoracic spine who acutely developed severe spinal cord compression and a T9 vacuum phenomenon fracture 7 months after her initial diagnosis. OUTCOME: The patient was treated with urgent decompression and T9 kyphoplasty, which resulted in complete resolution of her neurological deficits. CONCLUSIONS: The timeline of symptomatology in the case suggests that asymptomatic patients with T-spine extramedullary hematopoiesis can develop progressive neurologic deterioration and atraumatic compression fractures culminating in acute spinal cord injury. While it may be appropriate to treat asymptomatic patients conservatively, surgical decompression must always remain a consideration.