Soru

A $62$-year-old woman is evaluated in the emergency department for a $2$-week history of progressively worsening mid-back pain. This morning, she developed profound weakness in both legs and was unable to urinate. The patient has a history of estrogen receptor-positive breast cancer treated with a mastectomy and chemotherapy $5$ years ago, and she has been in remission since. Her temperature is $37.1^\circ\text{C}$ ($98.8^\circ\text{F}$), blood pressure is $135/85 \text{ mm Hg}$, and pulse is $88/\text{min}$. Physical examination reveals $3/5$ motor strength in both lower extremities, decreased pinprick sensation below the level of the umbilicus, and absent rectal sphincter tone. Laboratory studies show a leukocyte count of $7,200/\text{mm}^3$, an erythrocyte sedimentation rate of $18 \text{ mm/h}$, a serum calcium level of $10.1 \text{ mg/dL}$, and a serum albumin level of $3.0 \text{ g/dL}$. Magnetic resonance imaging of the thoracic and lumbar spine is performed immediately. The imaging reveals a solid, contrast-enhancing destructive lesion entirely contained within the T10 vertebral body, extending posteriorly into the anterior epidural space and causing severe compression of the spinal cord. The intervertebral discs at T9-T10 and T10-T11 maintain normal height and signal intensity, and there are no paraspinal or epidural fluid collections. Based on the interpretation of the imaging findings, which of the following is the most appropriate next step in management?