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Thoracic Schwannoma in an Adult Male Presenting With Thoracic Pain: A Case Report

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Abstract

Objective

The purpose of this case report was to describe a patient presenting with back pain subsequently diagnosed with thoracic schwannoma.

Clinical Features

A 45-year-old male presented to a chiropractic practice with mid-back, low back, and sacroiliac pain. Orthopedic examination revealed joint dysfunction in the thoracic–sacroiliac region with normal findings on neurologic examination. An initial diagnosis of thoracic spinal pain and sacroiliac sprain and strain was made. At approximately 7 weeks of treatment, because of the patient’s persistent pain, chest magnetic resonance imaging (MRI) was ordered by the chiropractic physician.

Interventions and Outcomes

The chest MRI revealed an intradural extramedullary mass at the T5 level creating a marked compression of the spinal cord. A thoracic MRI was conducted 2 days later confirming the presence of the tumor. The patient was successfully treated with spinal surgery to remove a schwannoma.

Conclusions

Mechanical spinal pain is a common symptom in patients presenting to chiropractic offices and may present concurrent with other pathology. In the presence of unresolved persistent thoracic pain, clinicians should investigate other potential causes.

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

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