The patient came to the clinic 02-December-2014 complaining of back pain for 8 months with numbness both feet last 2 weeks.

On examination, the patient is not limping with mild scoliotic stance. The left AJ is absent. There is weak dorsiflexion left foot 4/5. There is pain during percussion of the lower dorsal spine.

The patient was sent for MRI of the dorsal and lumbar spine. MRI lumbar done the same day showing huge cyst right kidney and bulge L3-4 and L4-5 disci. The dorsal spine showed intramedullary mass extending from D9 down to D10. Spectroscopy and DTI were performed and shown below.

Laminectomy D9,10 and partial of D8 and D11. The dura was opened. The tumor was seen under the surface of the medulla and it was expanding it to all directions. A small parallel to the midline incision were the tumor was seen was done through which a golden fluid came out. Attempt to remove the tumor through this small incision failed because the tumor was stuck to all walls of the spinal cord cavity. It was necessary to extend the posterior incision all over the tumor to achieve practical total removal. Inomed lumbar spine protocol was used, but it was troubleshooting, for what transpedicular set was used instead.  The roots above and at and below the resected tumor were functioning. The wound after meticulous hemostasis was closed and MRI of the tumor bed was done confirming total resection of the tumor.

Smooth postoperative recovery. The patient moving both lower limbs with more weakness in the right leg.

The patient after surgery cannot walk, despite the fact that the power of both lower limbs became normal. On examination there is hypalgesia of the right anterior thigh for pain light touch and temperature. The left foot is colder than the right. The deep reflexes are present both side more brisk in the right. She has bilateral disturbed. The 2 point discrimination is not achievable over all the body, which made it hopeless in the clinical evaluation. The conscious muscle joint sense is disturbed both sides more in the proximal muscles of the legs. We could make her walk 3-4 steps the 3d postoperative day and aggressive physiotherapy is undertaken.

The patient was bleeding all the time and after mutual conflict with the anaesthesia staff, they were told to decrease the patient high blood pressure and to give her Vit K 10 mg. after what it became more possible, but still difficult to work.

Fibertraking is misleading in pathological anatomy in the brain and spinal cord. This case failed to show the real thickness and distribution of the spinal cord fibers.

The entire tumor capsule was adherent to the spinal cord. It was necessary to perform long posterior incision, which can cause more neurologic sequelae.