Highlights
- •Cauda equina schwannoma along with lumbar intravertebral disc herniation is rare.
- •Concomitant small schwannoma and lumbar IVD herniation can cause symptom.
- •Enhanced MRI may be helpful in the detection of these tumors.
- •Associated symptoms can acutely worsen with concomitant lumbar IVD herniation.
Abstract
The coexistence of lumbar intervertebral disc (IVD) herniation and cauda equina schwannoma
in symptomatic patients is uncommon. We experienced a case with a surgically treated
cauda equina schwannoma with concomitant lumbar IVD herniation (L2/L3); both were
relatively small but presented with painful symptoms in combination. A 45-year old
man complained of low back pain and right anterior thigh pain six months prior to
surgery. He underwent conservative treatment; however, his pain suddenly worsened
three months before surgery, with abnormal sensations and pain in his right buttock
and posterior thigh. A magnetic resonance imaging (MRI) scan revealed an L2/L3 disc
herniation extruding to the center of the lumbar spinal canal and compressing the
thecal sac. Incidentally, an intrathecal tumor was suspected, and enhanced MRI revealed
a round tumor measuring 10-mm in diameter at the L2/L3 intervertebral level, which
was uniformly enhanced by gadolinium chelate, radiologically diagnosed as a schwannoma.
Microscopic discectomy and tumor resection were performed and the patient’s symptoms
disappeared immediately. Schwannoma is generally slow-growing, and usually asymptomatic
when the tumor size is small. Therefore, we suspected that the tumor occasionally
impinged on the left L3 root with L2/3 IVD herniation, leading to acute worsening
of the patient’s symptoms. Altogether, in case of tumor in patients undergoing conservative
treatment for cauda equina schwannoma, we should consider that symptoms can acutely
worsen with the occurrence of lumbar IVD herniation.
Keywords
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Article info
Publication history
Published online: January 09, 2019
Accepted:
December 23,
2018
Received:
November 29,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
