Topics in neurologyThoracic Schwannoma in an Adult Male Presenting With Thoracic Pain: A Case Report
Introduction
Primary spinal tumors are rare, with an incidence of 0.74 to 0.97 per 100 000 person-years, and account for approximately 4% to 16% of all central nervous system tumors.1, 2, 3 The most common sites are the spinal cord (60.5%), followed by the spinal meninges (36.0%), and the caudal equina (3.5%).1 Primary spinal tumors are divided into 3 categories based on their anatomic location: intramedullary, intradural extramedullary, and extradural.4 Intradural extramedullary (IE) tumors include schwannomas, neurofibromas, and meningiomas.5 Schwannomas can present with 2 main symptoms—radiculopathy and neurogenic claudication—as well as worsening sensorimotor loss and back pain radiating from the tumor level.6 Patients with unilateral localized spinal tumors are more likely to experience localized back pain, whereas concentric growths are associated with diffused pain and motor deficits.7
The prevalence of chronic back pain is rising and accounts for 10% of the population, with 84% of them seeking care from a health care provider.8 One of the recommended treatment options for low back pain (LBP) is spinal manipulative therapy.9, 10 Chiropractors are one of the most common health care providers that perform spinal manipulation therapy for back pain.11
The purpose of this case report is to describe a patient who presented for chiropractic care for back pain and was later diagnosed with a thoracic tumor.
Section snippets
Case Report
A 45-year-old male presented to a chiropractic practice for the first time with acute exacerbation of chronic LBP with sciatica and acute mid-back pain. Approximately 1 year before presentation, the patient had injured his lower back stepping off a curb while jogging, which had resulted in sciatic pain. An orthopedist had ordered lumbar magnetic resonance imaging (MRI), which revealed a small right disk extrusion at L4/L5 compressing on the descending nerve root. The patient started a regimen
Intervention and Outcome
A short trial of conservative chiropractic care, including chiropractic manipulative therapy (CMT) to the sacroiliac joints and to the thoracolumbar spine, was recommended. The CMT consisted of diversified techniques, administered with the patient in the prone position; a high-velocity, low-amplitude force was delivered either by an Activator instrument (not according to Activator protocol; Activator Methods, Phoenix, AZ) or by hand directed to his mid-thoracic and side posture for his lumbar
Discussion
This case is unusual in that there were several complicating factors in the clinical presentation. The patient had a history of trauma occurring close to the time of onset of the back pain, which led his health care providers to think that the pain was caused by musculoskeletal injuries. The initial examination by his chiropractor supported a diagnosis of thoracic spinal misalignment, with pinching of the local thoracic nerves and pain radiating to the intercostal nerves. Although spinal tumors
Conclusions
This case report describes a 45-year-old man with a schwannoma and concurrent mechanical back pain presenting to a chiropractic office. Persistent severe back pain not responding to short-term trial of chiropractic treatments should alert the clinician of other causes, and further assessment is indicated.
Funding Sources and Conflicts of Interest
No funding sources or conflicts of interest were reported for this study.
Contributorship Information
Concept development (provided idea for the research): A.M.R.
Design (planned the methods to generate the results): A.M.R.
Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): A.M.R.
Data collection/processing (responsible for experiments, patient management, organization, or reporting data): A.M.R.
Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): A.M.R.
Literature search (performed
References (14)
- et al.
Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial
Spine J
(2014) - et al.
Schwannoma: challenging diagnosis
J Manipulative Physiol Ther
(2001) - et al.
Ganglioneuroma masquerading as spinal pain
J Manipulative Physiol Ther
(2002) - et al.
Descriptive epidemiology of malignant and nonmalignant primary spinal cord, spinal meninges, and cauda equina tumors, United States, 2004-2007
Cancer
(2012) - et al.
Descriptive epidemiology of primary spinal cord tumors
J Neuro-Oncol
(2008) - et al.
Primary spinal cord tumors: review of 678 surgically treated patients in Japan. A multicenter study
Eur Spine J
(2012) Some aspects of the diagnosis and surgical treatment of tumors of the spinal cord: with a study of the end results in a series of 119 operations
Ann Surg
(1925)