1251 - Upper Extremity Robot-Assisted Therapy On A Patient With Recurrent Cervical Chordoma After Debulking With Sacrifice Of Right C5 Nerve Root: A Case Report

Case Diagnosis: C1 quadriparesis secondary to recurrent chordoma

Case Description: 72-year-old patient with chordoma was admitted to inpatient rehabilitation after undergoing C5 laminectomy with debulking of the tumor and the sacrifice of the right C5 nerve root. He had a 14-year history of recurrent right C2-C5 chordoma for which he underwent multiple debulking surgeries. He had C1 quadriparesis with profound right upper extremity (RUE) weakness, most significantly in biceps with a MMT of 0/5 and clonus. The Armeo Spring Upper Extremity Robotics device was utilized three times a week for three weeks for rehabilitation. During sessions, he was able to perform limited elbow flexion/extension, forearm pronation/ supination with no clonus. After 3 weeks of therapy, RUE MMT was the same but the ROM with the device showed 17 degrees increase on elbow, 21 degrees on forearm, 21 degrees on wrist. Increased FIM scores for eating, grooming, and UE dressing were observed.

Discussions: Cervical Chordoma is a rare malignant tumor from notochord remnants, that can emerge along the spine with aggressive local growth. Treatment typically involves surgery, radiation, and targeted therapies. Remarkably, Armeo Robotics with variable upper limb gravity support with a spring mechanism, enhanced right shoulder and wrist movements, enabling precise elbow and forearm actions. This led to an increased range of motion compared to the baseline.

Conclusions: This case demonstrates the use of innovative interventions such as upper extremity robot-assisted therapy to improve movement and the functionality of a patient with a rare case of recurrent cervical chordoma. Further use of this technology for rehabilitation should be explored.