Surgical Outcome of a Giant Dorsal Spinal Neurofibroma: A Case Report

Spinal neurofibromas are rare neurogenic tumors that can cause progressive neurological deficits due to spinal cord compression. Early diagnosis and timely surgical intervention are crucial to prevent permanent neurological impairment and restore functional mobility.

A 38-year-old male presented to Ibn Sina Medical College Hospital with persistent mid-back pain and progressive weakness in both lower limbs, which eventually caused difficulty in independent ambulation. Neurological examination revealed decreased motor strength in the lower limbs (Medical Research Council [MRC] Grade - 4/5), sensory deficit below the D6 dermatome, and exaggerated deep tendon reflexes. Magnetic resonance imaging (MRI) of the thoracic spine demonstrated a large, well-defined, dumbbell-shaped paraspinal mass at the thoracic spine levels 5 and 6 (D5-D6) vertebral level, extending through the intervertebral foramen into the spinal canal with significant spinal cord compression. Based on clinical and radiological findings, a diagnosis of thoracic spinal neurofibroma (dumbbell type) was made. The patient underwent complete surgical excision of the tumor with spinal stabilization under general anesthesia. Intraoperatively, the tumor was encapsulated and extended from the spine to the subcutaneous tissue and right chest wall, destroying the D5-D6 vertebral body, lamina, pedicles, and part of the 5th and 6th ribs. Histopathology confirmed the diagnosis of neurofibroma. Postoperatively, the patient's neurological function gradually improved, and follow-up imaging confirmed complete tumor resection with no residual compression. At 1-month follow-up, he was mobilizing independently, with significant pain relief and no surgical complications. At 4 years follow-up, the patient achieved independent ambulation, and neurological function had returned to normal.

Surgical excision with spinal stabilization is an effective treatment for thoracic dumbbell-shaped neurofibromas. Early diagnosis and intervention can lead to excellent neurological recovery, restoration of mobility, and improved quality of life.