RT Journal Article SR Electronic T1 Metastatic Paraganglioma of the Spine With SDHB Mutation: Case Report and Review of the Literature JF International Journal of Spine Surgery JO Int J Spine Surg FD International Society for the Advancement of Spine Surgery SP S37 OP S45 DO 10.14444/7163 VO 14 IS s4 A1 Rashad Jabarkheel A1 Arjun V. Pendharkar A1 Jonathan L. Lavezo A1 Justin Annes A1 Kaniksha Desai A1 Hannes Vogel A1 Atman M. Desai YR 2021 UL http://ijssurgery.com//content/14/s4/S37.abstract AB Background: Paragangliomas (PGLs) are rare neuroendocrine tumors that can arise from any autonomic ganglion of the body. Most PGLs do not metastasize. Here, we present a rare case of metastatic PGL of the spine in a patient with a germline pathogenic succinate dehydrogenase subunit B (SDHB) mutation.Methods: In addition to a case report we provide a literature review of metastatic spinal PGL to highlight the importance of genetic testing and long-term surveillance of these patients.Results: A 45-year-old woman with history of spinal nerve root PGL, 17 years prior, presented with back pain of several months' duration. Imaging revealed multilevel lytic lesions throughout the cervical, thoracic, and lumbar spine as well as involvement of the right mandibular condyle and clavicle. Percutaneous biopsy of the L1 spinal lesion confirmed metastatic PGL and the patient underwent posterior tumor resection and instrumented fusion of T7–T11. Postoperatively the patient was found to have a pathogenic SDHB deletion.Conclusions: Patients with SDHx mutation, particularly SDHB, have increased risk of developing metastatic PGLs. Consequently, these individuals require long-term surveillance given the risk for developing new tumors or disease recurrence, even years to decades after primary tumor resection. Surgical management of spinal metastatic PGL involves correcting spinal instability, minimizing tumor burden, and alleviating epidural cord compression. In patients with metastatic PGL of the spine, genetic testing should be considered.