Melorheostosis affecting contiguous multi-segment thoracic vertebrae resulting in bilateral lower limb paralysis: A case report

Background: Melorheostosis is a non-hereditary, benign, sclerotic bone dysplasia that typically affects a single limb, involving both bones and adjacent soft tissues. It is rare in both clinical and radiological presentations.As the disease rarely involves the spine and exhibits inconspicuous early symptoms, it is frequently overlooked, leading to delayed diagnosis and missed treatment windows. Recently, we successfully diagnosed and managed a patient. Case presentation: A 30-year-old male presented with a one-year history of progressive numbness and weakness in both lower limbs without obvious cause. Following a full-length X-ray of the lower limbs, a diagnosis of melorheostosis was considered, and conservative drug therapy was initiated. However, his symptoms worsened, progressing to paraplegia.At our hospital, further spine computed tomography (CT) and magnetic resonance imaging (MRI) revealed multiple signal changes in the thoracic vertebrae, spinal canal stenosis at the T6-T8 levels, and spinal cord degeneration at the corresponding segments.The patient underwent thoracic spinal canal decompression surgery, resulting in significant improvement in the symptoms of both lower limbs postoperatively. Conclusion: This case suggests that in patients with melorheostosis presenting with neurological symptoms, potential spinal involvement should be considered. Comprehensive spinal examinations and timely diagnosis and treatment are essential for better prognosis.