Sudden Post-Traumatic Sciatica caused by a
Thoracic Spinal Meningioma

Spinal meningiomas are typically slow-growing and benign tumors that arise from the membranes surrounding the spinal cord. They most often affect young adults and older women. Because these tumors grow gradually, symptoms usually develop slowly over several years. The earliest symptom is often localized back pain, followed by leg weakness or radiating nerve pain as the tumor enlarges and compresses the spinal cord or nerve roots.

Sudden symptom onset, particularly sciatica following trauma, is extremely rare in spinal meningiomas. This type of presentation can occur when an external event, such as an accidental fall, triggers acute nerve compression or stretching in a spine already compromised by an undiagnosed tumor.

Functional Anatomy

The spinal cord is encased in three protective layers called meninges — the dura mater, arachnoid mater, and pia mater. Meningiomas develop from the arachnoid layer and can occur anywhere along the spinal column. Thoracic spinal meningiomas, located in the middle of the spine, are the most common form.

The thoracic region plays an important role in transmitting signals between the brain and the lower body. A tumor pressing on this area can disturb both motor and sensory pathways, leading to weakness, pain, and reflex abnormalities that may extend to the legs.

Biomechanics or Physiology

When a spinal meningioma compresses the spinal cord or nerve roots, it disrupts the normal flow of signals and blood supply. This compression can cause back pain, leg weakness, numbness, and sciatica-like symptoms.

In rare cases, trauma can worsen an existing but previously silent tumor. A sudden fall or jolt can increase pressure within the spinal canal, stretch nerve roots, or temporarily shift the spinal cord, producing abrupt neurological symptoms.

Common Variants and Anomalies

Spinal meningiomas are most commonly found in the thoracic spine, followed by the cervical and lumbar regions. They are usually intradural and extramedullary, meaning they grow inside the spinal canal but outside the spinal cord.

Most are benign (WHO Grade I), but atypical or more aggressive forms (WHO Grade II) can occur. The sudden onset of symptoms may be related to factors such as tumor hemorrhage, concurrent trauma, or displacement of the spinal cord and nerve roots.

Clinical Relevance

A striking example is a reported case of a 35-year-old woman who developed sudden low-back pain radiating to her right leg and weakness after a minor fall. She had been completely symptom-free before the incident.

Although a CT scan showed no abnormalities, MRI revealed a tumor at the T11 level compressing the spinal cord. This unexpected location explained the sudden onset of sciatic-type pain and leg weakness, which are typically associated with lower spinal conditions.

This case highlights that when patients experience acute sciatica following trauma but lumbar imaging is normal, upper spinal causes such as thoracic meningiomas should be considered.

Imaging Overview

MRI is the diagnostic tool of choice for identifying spinal meningiomas. It can reveal the size, location, and extent of the tumor, as well as its relationship to the spinal cord and nerve roots.

In this case, the MRI clearly showed a left-sided mass at the T11-T12 level displacing the spinal cord. CT scans may appear normal, particularly if the tumor is intradural and does not cause visible bone changes.

Associated Conditions

Spinal meningiomas are occasionally associated with neurofibromatosis type 2, a genetic condition predisposing patients to nervous system tumors. However, most cases are isolated.

Other conditions that can complicate diagnosis include degenerative spine disease or lumbar disc herniation, which may initially mask or mimic the symptoms of a thoracic lesion.

Surgical or Diagnostic Applications

Surgical removal is the primary treatment for spinal meningiomas. In the reported case, the tumor was excised through microsurgical dissection. Histopathology confirmed an atypical (WHO Grade II) meningioma attached to the dura mater.

Post-surgery, the patient recovered rapidly with physiotherapy, regaining leg strength and mobility. MRI follow-up showed no residual tumor or spinal cord compression, confirming complete recovery.

This outcome emphasizes that early surgical intervention can lead to excellent neurological recovery, even in cases presenting with sudden symptoms.

Prevention and Maintenance

While spinal meningiomas cannot be prevented, early detection and evaluation of unexplained neurological symptoms can help avoid permanent deficits. Patients experiencing persistent or unexplained back or sciatic pain — especially when imaging of the lower spine is normal — should undergo full spinal MRI screening.

After surgery, physical therapy is essential to restore strength, coordination, and walking ability. Regular follow-up imaging ensures that the tumor does not recur.

Research Spotlight

A recent case report described a 35-year-old woman who developed sudden right-sided sciatica and leg weakness following a minor fall, ultimately diagnosed as a thoracic spinal meningioma. MRI revealed an intradural extramedullary tumor at the T11 level on the left side of the canal, compressing the spinal cord and displacing it to the right.

Surgical removal of the tumor, which was confirmed as an atypical (WHO grade II) meningioma, led to rapid pain resolution and full neurological recovery within five months. The authors proposed that the trauma transmitted force through the spine, stretching the already compressed cord and lumbosacral nerve roots displaced by the tumor.

While spinal meningiomas typically produce slow, progressive symptoms, this case demonstrates that acute trauma can trigger abrupt symptom onset due to cord or root stretching. The report emphasizes that sudden post-traumatic sciatica with normal lumbar MRI should prompt evaluation of the lower thoracic spine for possible cord compression. (Study of post-traumatic sciatica caused by thoracic spinal meningioma – See PubMed.)

Summary and Key Takeaways

Thoracic spinal meningiomas are rare causes of sudden post-traumatic sciatica. Although these tumors usually develop slowly, minor trauma can reveal their presence by disturbing spinal cord alignment or increasing compression.

When sciatica appears abruptly after a fall and lumbar scans are normal, clinicians should consider the possibility of thoracic or upper spinal lesions. Surgical removal of the tumor typically leads to rapid and complete recovery, especially when performed early.

Timely diagnosis and comprehensive spinal evaluation are essential to ensure the best outcomes and prevent long-term neurological damage.