Background: The purpose of this report was to describe the clinical course, management, and outcomes of a male with thoracolumbar spine pain associated with an intradural schwannoma.
Case presentation: A 49-year-old male sought care at an interdisciplinary medical clinic with rapid onset of paraspinal pain to the left of the thoracolumbar junction. The initial examination indicated myofascial trigger point pain of the left quadratus lumborum. The patient's management included manual myofascial trigger point pressure release, active and passive muscle stretching, trigger point injections, prescription anti-inflammatory medication, prescription muscle relaxant medication, and narcotic pain medications over an 8-week period with a moderate reduction in pain. Following sixtreatment sessions, the patient reported a progression of left thoracolumbar paraspinal pain intensity, nocturnal low back pain, left hip and thigh pain, and bilateral leg weakness. The patient was referred for thoracolumbar spine magnetic resonance imaging, which demonstrated a lower thoracic spine intradural tumor effacing the conus medullaris. The patient was immediately referred for neurosurgical excision. Following surgery, the patient experienced complete remission of thoracolumbar spine pain and recovered his lower extremity strength. Histological evaluation later revealed the mass to be a lower thoracic intradural extramedullary schwannomacausing compression of the conus medullaris.
Discussion: Clinicians managing persistent paraspinal trigger points with progressive pain and neurological dysfunction should be aware of the possibility of undiagnosed co-morbidities as complicating factors in clinical presentation. Progressive pain and neurological findings warrant referral for advanced imaging to screen for undiagnosed complicating conditions, such as an intradural mass. In this case, conus medullaris compression mimicked the clinical presentation of myofascial trigger point syndrome within the quadratus lumborum musculature and was later discovered to be associated with a lower thoracic benign intradural schwannoma.
Conclusion: This case report describes the clinical presentation of a lower thoracic benign intradural schwannoma initially presenting with characteristics of myofascial pain. Serious neurological conditions may present with symptoms mimicking common musculoskeletal disorders.
Author keywords: Spinal Cord Tumor; Compression, Spinal Cord; Myelopathy, Compressive; Myofascial Pain Syndrome; Trigger Point; Chiropractic
Author affiliations: CBR: Assistant Professor, Palmer College of Chiropractic Life Science & Foundations Department; GAA: Adjunct Instructor, Kirkwood Community College; CSO: Doctor of Chiropractic, VA Medical Center Minneapolis, MN; MJR: Medical Doctor and Doctor of Chiropractic, Hiawatha, IA
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