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Coexistence of intervertebral disc herniation with intradural schwannoma in a lumbar segment: a case report.
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Pathological studies confirmed the intradural lesion was schwannoma.The case report highlights a rare concomitance of two symptomatic pathologies in a lumbar spine, which deserves clinical attention.Complete history, careful physical examination, and investigative measures, such as contrast MR imaging, are helpful to establish throughout diagnoses.
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PubMed Central - PubMed
Affiliation: Spine Lab, Department of Orthopedic Surgery, The 1st Affiliated Hospital of Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, China.
ABSTRACT
Background: Lumbar intervertebral disc herniation and spinal tumor are major pathologies that may cause back pain and radiculopathy. Neurological symptoms resulting from disc herniation and intradural spinal tumor together, however, are very rare. Case presentation: We report a case of lumbar disc herniation which coexists with intradural schwannoma at the same spinal level in a 67-year-old man. The patient presented with persistent low back pain, sciatica, and weakness of the lower limbs. Contrast lumbar spine magnetic resonance (MR) imaging clearly delineated an intradural lesion and an extradural herniated disc at L3/4 level. Using a single posterior approach, both pathologies were addressed. Pathological studies confirmed the intradural lesion was schwannoma. Conclusion: The case report highlights a rare concomitance of two symptomatic pathologies in a lumbar spine, which deserves clinical attention. Complete history, careful physical examination, and investigative measures, such as contrast MR imaging, are helpful to establish throughout diagnoses. No MeSH data available. Related in: MedlinePlus |
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Fig1: T2-weighted sagittal image (a) revealed L3/4 disc herniation which compressed the dural sac from the right side. Two slices away, there was a hyperintense intradural mass at the same level (b). T1-weighted sagittal image (c) demonstrated a hypointense mass behind the L3/4 intervertebral disc Mentions: On physical examination, there was mild tenderness on L3-5 spinous processes. While straight leg raising test was negative, femoral stretch test was positive at both sides. Neurological examinations revealed decreased muscle power for the right quadriceps femoris and left tibialis anterior (Manual Muscle Test grade IV). His knee and ankle reflexes at the right leg disappeared, and sensation at the medial side of his left calf diminished. Pathological reflexes were negative at both legs. Lumbar spine MR imaging revealed an intradural lesion (14 × 8 mm2) at the left side of the dural sac and a herniated disc of moderate size at the right lateral recess of the L3/4 spinal canal (Figs. 1 and 2).Fig. 1 |
View Article: PubMed Central - PubMed
Affiliation: Spine Lab, Department of Orthopedic Surgery, The 1st Affiliated Hospital of Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, China.
Background: Lumbar intervertebral disc herniation and spinal tumor are major pathologies that may cause back pain and radiculopathy. Neurological symptoms resulting from disc herniation and intradural spinal tumor together, however, are very rare.
Case presentation: We report a case of lumbar disc herniation which coexists with intradural schwannoma at the same spinal level in a 67-year-old man. The patient presented with persistent low back pain, sciatica, and weakness of the lower limbs. Contrast lumbar spine magnetic resonance (MR) imaging clearly delineated an intradural lesion and an extradural herniated disc at L3/4 level. Using a single posterior approach, both pathologies were addressed. Pathological studies confirmed the intradural lesion was schwannoma.
Conclusion: The case report highlights a rare concomitance of two symptomatic pathologies in a lumbar spine, which deserves clinical attention. Complete history, careful physical examination, and investigative measures, such as contrast MR imaging, are helpful to establish throughout diagnoses.
No MeSH data available.
