"An unusual presentation of a sacral Ewing's sarcoma in a young Syrian female"

A primary spinal Ewing sarcoma is extremely rare to be found. To the best of our knowledge, it is the first reported case for bilateral foot drop as a prodromal symptom of sacral Ewing sarcoma. The case, we are presenting, is of an 18-year-old athletic female, who was presented to the emergency department suffering from sudden severe low back pain radiated to the lower limbs, associated with bilateral foot drop and later urinary incontinence. Following the indicated surgery and subsequent histopathology study, we diagnosed this rare type of tumors. In the following article, we are describing the clinical presenting features of this tumor and discussing the clinical aspects.

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Sacral primary Ewing's sarcoma is a rare tumor.

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Diagnosis of sacral Ewing's sarcoma is quite challenging.

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Isolated back pain should be investigated widely.

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Bilateral foot drop may be noticed as a prodromal symptom in sacral Ewing sarcomas.

Acute Bilateral Isolated Foot Drop: Changing the Paradigm in Management of Degenerative Spine Surgery with Percutaneous Endoscopy

BACKGROUND

Acute bilateral isolated foot drop due to lumbar disk prolapse with canal stenosis is rare with only 3 cases reported in literature. Our patient was managed using the percutaneous full endoscopic technique. This is mainly to highlight the ease of access and patient outcome with preoperative and postoperative images to support our minimally invasive treatment for this rare condition.

CASE DESCRIPTION

A 46-year-old male presented with sudden-onset severe back pain with bilateral foot drop. Clinical examination showed a bilateral L5 radiculopathy with normal perianal sensation. Investigations excluded other causes of bilateral foot drop. A magnetic resonance imaging scan showed disk herniation at the right L4-L5 (inferior migrated) and L5-S1 level (paracentral and extraforaminal) with spinal canal stenosis at the L2-L3 and L5-S1 levels due to ligamentum flavum hypertrophy. The patient underwent percutaneous endoscopic stenosis lumbar decompression at the L2-L3 and L5-S1 level. At the right L4-L5, L5-S1 level, transforaminal endoscopic diskectomy was done using the conventional percutaneous approach. The inferior migrated disk of the L4-L5 level was removed using a left L5-S1 contralateral approach. The patient recovered with favorable outcome and added benefits of minimally invasive surgery.

CONCLUSION

Lumbar disk prolapse with canal stenosis should be considered in patients presenting with bilateral isolated foot drop. To our best knowledge, this is the first report of percutaneous endoscopic treatment to address multiple-lumbar-level pathology for this rare condition of acute bilateral isolated foot drop.

Acute Bilateral Foot Drop as Presenting Symptom of Hemorrhagic Synovial Cyst of Lumbar Spine

BACKGROUND

Acute bilateral foot drop is a rare clinical presentation.

CASE DESCRIPTION

A 77-year-old male presented with acute bilateral weakness of the foot and ankle dorsiflexion. Magnetic resonance imaging of the lumbar spine revealed ligamentum flavum hypertrophy, as well as a mass lesion that appeared hyperintense on T1-weighted images and hypointense on T2-weighted images. Emergent decompressive laminectomy and hemorrhagic synovial cyst excision were performed. Histopathologic examination of the tissue revealed a synovial cyst with hemorrhage.

CONCLUSION

Here, we describe a unique case of a hemorrhagic synovial cyst with a presenting symptom of acute bilateral foot drop.

Acute bilateral isolated foot drop: Report of two cases

Foot drop is defined as the weakness of the foot and ankle dorsiflexion. Acute unilateral foot drop is a well-documented entity, whereas bilateral foot drop is rarely documented. Slowly progressing bilateral foot drop may occur with various metabolic causes, parasagittal intracranial pathologies, and cauda equina syndrome. Acute onset of bilateral foot drop due to disc herniation is extremely rare. Here we present two cases of acute bilateral foot drop due to disc herniation. The first patient was a 45-year-old man presented with acute bilateral foot drop, without any sign of the cauda equina syndrome. Lumbar magnetic resonance imaging of the patient revealed L4-5 disc herniation. To our knowledge, this is the first presented case of acute bilateral foot drop without any signs of cauda equina syndrome caused by L4-5 disc herniation. The second patient was a 50-year-old man who was also presented with acute bilateral foot drop, and had T12-L1 disc herniation with intradural extension. Also this is the first presented case of T12-L1 disc herniation with intradural extension causing acute bilateral foot drop. We performed emergent decompressive laminectomy to both of the patients and extrude disc materials were excised. Both of the patients were recovered with favorable outcome.