Intercostal Neuralgia and Spinal Cord Compression Symptom due to Spinal Tumor -A Case Report-

척추 종양에 의한 늑간 신경통 및 척수 압박 증상 -증례 보고-

A 49 years old male patient was admitted to our neuro-pain clinic with symptoms of left 11th intercostal neuralgic pain and low back pain that developed 2 months prior to admission. Upon initial physical examination, motor weakness or sensory deficit were absent. Intercostal neuralgic pain improved significantly after we performed thoracic root thermocoagulation. However on the afternoon of the procedure the patient started to experience voiding difficulty, saddle anesthesia and rapidly progressing motor weakness and hypoesthesia that involved the lower back area and the lower extremities for three days. Based on these symptoms spinal cord compression was suspected and subsequently plain T-L spine X-rays and T-L spine MRI were performed. A spinal tumor that appeared metastatic in origin was seen at the T11 and T12 level. Liver ultrasonography demonstrated the presence of a $4{\times}4cm$ sized ill defined mass in the posterior segment of the right lobe. The patient was diagnosed to have hepatocellular carcinoma after needle aspiration biopsy and cytologic studies. Further orthopedic surgery was recommended but as the patient rejected any further treatment and examination, it was not possible to confirm the primary focus of the tumor. However as metastasis of a primary liver tumor to the spine is a rare occurrence, some other primary focus of metastasis or even a malignant primary tumor of the spine is more likely to explain this patient's condition.

좌측 제 11번 늑간 신경통과 요통을 주소로 입원한 49세 남자 환자에게 흉부 신경근 열 응고술을 시행한 후 3일간에 걸쳐 척수 압박 증상이 급속히 진행되었다. 흉 요추의 단순 X-선과 자기 공명 영상 촬영으로 밝힌 그 원인은 제 11 및 12 흉추의 척추 종양이었다.