Traction Radiculopathy After Surgery for Lumbar Spinal Metastasis: A Case Report

Treatment of spinal metastasis has attracted much attention globally, especially in Japan, with the advancement of cancer therapy. Among the metastases, those from breast and prostate cancers may be more important than others considering the high incidence of bone metastasis and the long-term prognosis. This condition often results in surgical procedures of spinal metastases to improve cancer patients' quality of life (QOL). In the present case, a patient with lumbar metastasis of breast cancer presented with right L5 nerve palsy after palliative laminectomy surgery with posterior fusion. The nerve palsy had improved after additional bone resection around the right L5 root. The mechanism of this postoperative leg paralysis was subclinical nerve root damage due to the narrowing of the intervertebral foramen caused by the tumor protrusion like lumber disc hernia and the stretching of the nerve roots caused by the posterior shift of the dural tube. When performing decompression and fixation of a metastatic spine showing a herniated tumor formed by a tumor protruding posteriorly into the intervertebral foraminal space, sufficient tumor mass debulking should be considered to avoid postoperative intervertebral foraminal stenosis.