What happened, in summary

A 59-year-old man had lung adenocarcinoma originally staged as cT1bN2M0, Stage IIIA. Chemotherapy had started 10 years earlier, and he had received 10 different anticancer drugs over time. His tumor sometimes shrank and sometimes grew, but complete remission was never achieved. Two years before the emergency described in this case, cervical spine metastasis was detected and treated with radiation therapy, 20 Gy in 5 fractions. He later developed sudden neck pain while farming, followed by progressive weakness in all 4 limbs and urinary dysfunction. Within 3 days, he presented to the emergency department. During evaluation, his condition worsened to severe quadriparesis with hand sensory disturbance and urinary retention. MRI showed cervical epidural fluid collection with spinal cord compression, initially raising concern for an acute epidural hematoma. Emergency surgery found light yellow serous exudate rather than a clear hematoma. The team drained the epidural space and performed partial C3 laminectomy, complete C4 and C5 laminectomy, and partial C6 laminectomy for decompression. He initially recovered full strength in most muscle groups and could walk independently. By postoperative day 20, weakness returned, and MRI showed recurrent fluid collection. Fluid and CSF testing revealed atypical malignant cells. At reoperation on postoperative day 21, the C3 lamina involved by lung cancer metastasis was completely removed. After the second surgery, spinal cord compression did not recur, but he was left needing light assistance to walk and was discharged home 29 days later with substantial disability. The clinical course illustrates how metastatic spinal disease can cause abrupt neurologic decline even after prior radiation, and why repeat decompression was needed when malignant epidural fluid returned.