1234 - Gait Rehabilitation for a Rare Spinal Teratoma: New Techniques for Addressing Proprioceptive Impairment

Intramedullary Thoracic Spine Mature Teratoma

Case Description:

A previously healthy 26-year-old male presented with a thoracic spine mass in the setting of progressive gait abnormality, bladder and bowel incontinence, lower extremity paresthesias, and unintentional weight loss. Following T9-T10 laminectomy with mass resection, pathology revealed a mature teratoma with ectodermal, endodermal, and mesodermal elements. On admission to acute inpatient rehabilitation, the patient had bilateral lower extremity impairments with light touch, proprioception, and genu recurvatum, yet intact strength and deep pressure sensation. Anterior shell ankle foot orthoses helped address the recurvatum but not proprioception, requiring further interventions for gait safety. Bilateral hip to ankle TheraBands were experimented to provide sensory and proprioceptive feedback. This intervention improved recurvatum, increased number of steps, and increased the patient’s base of support (BOS). He progressed from moderate assistance with a rolling walker to supervision for ambulation and activities of daily living (ADLs).

Discussions:

Mature teratomas are low grade cystic tumors consisting of any combination of germ layer derivatives like hair, cartilage, bone, or adipose tissue. Spinal teratomas are rare, making up 0.15-0.18% of spinal tumors. They are typically managed by surgical resection and can cause functional complications in which there is little research regarding recovery. This mass location resulted in posterior cord syndrome causing proprioceptive deficits and paresthesias with intact strength, producing unique obstacles to improve gait and function. This case presents a novel approach utilizing TheraBand support to target proprioceptive deficits and improve gait related to BOS, average number of steps, and genu recurvatum.

Conclusions: This rehabilitation admission following a rare tumor resection created an opportunity to creatively address proprioceptive deficits, in this case utilizing resistance bands for sensory feedback rather than strengthening. Physiatrists are well situated within interdisciplinary teams to create new interventions to individualize treatments when faced with complex symptoms or setbacks during rehab courses.