Tandem Thoracic Spinal Cord Lesions of Differing Pathologies: Concurrent Metastatic Lung Adenocarcinoma Lesion in Close Proximity to a Intradural Meningioma.

Simultaneously having two pathologically distinct neoplastic lesions causing critical spinal stenosis is exceedingly rare. When such lesions are near one another but occupy different spinal compartments, significant challenges arise. We present the case of a patient with metastatic non-small cell carcinoma to the thoracic spine and an intradural meningioma occurring two spinal segments from each other. A 66-year-old female presented with one month of progressive mechanical back pain and two days of lower extremity weakness and urinary retention. She was found to have a left upper lobe lung mass. An urgent biopsy demonstrated non-small cell lung carcinoma. MRI of her thoracic spine demonstrated a T9 intradural-extramedullary enhancing lesion simultaneously with a destructive lesion of the T11 vertebral body extending into the anterior epidural space with significant cord compression at T9 and T11. The patient was taken for an urgent posterior decompression from T9 to T11, T9 left-sided pediculectomy with resection of intradural tumor, T11 corpectomy with anterior cage reconstruction, and instrumented fixation from T7 to L2. The pathology from the T9 lesion demonstrated findings consistent with a meningioma while the T11 lesion confirmed metastatic non-small cell lung adenocarcinoma. The patient improved neurologically postoperatively and regained the ability to ambulate within one week of surgery. Pathologically distinct spinal lesions in close anatomic proximity, but in two separate compartments are exceptionally rare. We performed a simultaneous posterior approach for resection of the T9 meningioma and a T11 corpectomy for the metastatic lesion with rapid neurologic recovery.