Acute Spinal Cord Injury in the Setting of C6 Pathologic Fracture Secondary to Metastatic Paraganglioma - A Case Report and Review of Literature

Sep 29, 2026

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Paragangliomas are rare extra-adrenal neuroendocrine tumors derived from neural crest chromaffin cells, and metastatic involvement of the spine in the cervical region is exceptionally uncommon. This case report describes a 25-year-old male with metastatic spread from a recurrent functional aortocaval paraganglioma to the cervical spine, culminating in a pathological fracture, acute spinal cord injury, and neurogenic shock requiring urgent intervention.

LanguageEnglish

CategoryHealthcare

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Pages9

Reading Time23 min

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Received 08/15/2025 Review began 10/01/2025 Review ended 12/01/2025 Published 12/03/2025 © Copyright 2025 Kaur et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98403 Open Access Case Report Published via University of Louisville Neurosurgery Acute Spinal Cord Injury in the Setting of C6 Pathologic Fracture Secondary to Metastatic Paraganglioma: A Case Report and Review of Literature Arshi Kaur 1, Sarah Danehower 1, Hannah G. Rupp 1, Ramin Hamidi 2, Mercia J. Bezerra Gondim 3 , Thomas Altstadt 1 1. Neurological Surgery, University of Louisville, Louisville, USA 2. Diagnostic Radiology, University of Louisville, Louisville, USA 3. Pathology and Laboratory Medicine, University of Louisville, Louisville, USA Corresponding author: Thomas Altstadt, [thomas.altstadt@uoflhealth.org](thomas.altstadt@uoflhealth.org) Abstract Paragangliomas (PG) are rare extra-adrenal neuroendocrine tumors that arise from neural crest-derived chromaffin cells. Metastatic involvement of the spine, particularly in the cervical region, is exceptionally uncommon. Here, we present an exceedingly rare case of a 25-year-old male with metastatic spread from arecurrent functional aortocaval paraganglioma to the cervical spine, ultimately leading to a pathological fracture, acute spinal cord injury, and neurogenic shock requiring urgent intervention. Categories: Neurosurgery Keywords: cervival metastasis, malignant, paraganglioma, pathologic fracture, rare Introduction Paragangliomas (PGs) are rare neuroendocrine neoplasms arising from chromaffin cells of neural crest progenitors located extra-adrenally [1] . PGs account for 0.3% of all neoplasms and typically occur in the fifth or sixth decade of life [2-4]. 10% of PGs are malignant [5] and are diagnosed by either local recurrence after resection of the primary mass, or findings of distant metastasis [3,6] . Metastatic lesions include bone, lymph nodes, lung, and liver [1,7] . Metastasis to the vertebrae is extremely rare [3,8-9], with cervical metastasis being the rarest of all [3,6] . Isolated reports identify the presence of cervical PG [3,6], but only one other case, to the best of our knowledge, has resulted in pathologic fracture with acute quadriparesis [10]. Here we present an exceedingly rare case of a 25-year-old male with metastasis of a recurrent functional aortocaval PG to the C5-C7 vertebrae, ultimately resulting in a fracture and subsequent acute spinal cord injury with neurogenic shock. Case Presentation A 25-year-old male with no reported past medical history presented to the emergency department with neck pain and ASIA B spinal cord injury at the C6 level after falling five feet off the back of a truck. Patient denied loss of consciousness, or extreme flexion or extension of his neck. MRI revealed collapse of the C6 vertebral body secondary to destructive tumor infiltration with superimposed extra-osseous extension of tumor/disc/hematoma complex into the prevertebral and anterior epidural spaces (Figure 1) . There is significant compression at C5-C6 with resultant cord edema extended from upper C4 to upper T1 levels. Furthermore, an anterior flexion teardrop fracture of C5 with posterior ligamentous contusion was also identified. How to cite this article Kaur A, Danehower S , Rupp H G , et al. (December 03 , 2025) Acute Spinal Cord Injury in the Setting of C6 Pathologic Fracture Secondary to Metastatic Paraganglioma: A Case Report and Review of Literature. Cureus 17(12): e98403. DOI 10.7759/cureus.98403 Published via University of Louisville Neurosurgery FIGURE 1 : Sagittal STIR and Axial T2 MRI demonstrating metastatic paraganglioma with cervical vertebral collapse, ligamentous injury, and spinal cord compression. (a

FAQs

What condition links metastatic paraganglioma to an acute C6 spinal cord injury in this case?

Metastatic spread to the cervical spine led to a C6 pathological fracture, resulting in acute spinal cord injury and neurogenic shock.

What did MRI show at the C5-C7 level?

MRI showed collapse of the C6 vertebral body with destructive tumor infiltration, extra-osseous extension into prevertebral and anterior epidural spaces, and significant compression with cord edema from upper C4 to upper T1.

How was the injury described clinically after the fall?

A 25-year-old male presented with neck pain and an ASIA B spinal cord injury at the C6 level after falling five feet from a truck, without reported loss of consciousness.

Sep 29, 2026

Uploaded by Marglet