1136 - Spinal Cord Injury Management in a patient with Radiation Myelopathy and Metastatic Breast Cancer

Case Diagnosis: Our patient was a 32 y/o female with significant past medical history of chronic non-traumatic spinal cord injury, T1 AIS C incomplete paraplegia, secondary to metastatic breast cancer status post multiple courses of chemotherapy complicated by extensive osseous involvement with T9 vertebral resection & spinal fixation with radiation myelopathy (2021).

Case Description: She presented with worsening lower extremity spasticity causing difficulty with lower extremity dressing, balance and ambulation. At admission our patient was moderate assistance with ADLS, ambulated only 5 feet without AFOs and rolling walker due limited endurance due to fatigue. After her AIR stay, she ambulated 32 ft with a rolling walker and AFOs. She improved to set up/supervision with ADLs. We also optimized pain/spasticity with medical/procedural interventions.

Discussions: The focus of this case study is to outline the rehab specific needs and benefits in patients with radiation myelopathy and to address the adverse health outcomes that occur in patients with SCI and breast cancer. There is a lack of literature evaluating chemotherapy/radiation complications specific to SCI patients. The rate of cancer is increasing in the SCI population and overall, in the United States. The physiatrist’s role has become crucial in managing long term effects of radiation/chemotherapy and its effect on daily function in an SCI patient.

Conclusions: In patients with SCI and cancer related radiation myelopathy, it is important to mitigate the risks of immunosuppression, optimize wound care, and prevent worsening spasticity/neurogenic bowel bladder. Our study outlines the importance of inpatient rehabilitation in this specific patient population.