Thoracic Schwannoma as an Unusual Cause of Sciatic Pain in the Chiropractic Office

Thoracic Schwannoma as an Unusual Cause of Sciatic Pain in the Chiropractic Office

Sciatica, which is pain radiating along the sciatic nerve distribution, is most often caused by degenerative con- ditions of the lower back and rarely results from lesions of the spinal cord. This case report illustrates a pa- tient with suspected lumbar radiculopathy, ultimately diagnosed with a thoracic schwannoma after visiting a chiropractor. A 61-year-old woman presented to a chiropractor with progressively worsening lower back pain radiating to the right lower extremity and unsteady gait. Her symptoms began 10 years previously and she had been diag- nosed by an orthopedist with lumbar disc herniation causing radiculopathy via magnetic resonance imaging (MRI) and was treated with physical therapy and diclofenac. Upon examination by the chiropractor, the patient had bilateral lower-extremity neurologic deficits, hyperreflexia, and upgoing Babinski responses. The chiroprac- tor ordered thoracic MRI, but the patient preferred to initiate a trial of care, which was unsuccessful. After a delay imposed by cardiac bypass surgery, the patient returned to the chiropractor with worsened symptoms and underwent thoracic MRI, revealing an intraspinal mass at T9. The patient underwent laminectomy and tu- mor removal, with histopathology confirming a diagnosis of schwannoma. The patient gradually improved af- ter surgery with the help of rehabilitative exercises. Clinicians should suspect a spinal cord lesion as a cause of sciatic pain when patients fail to improve with treat- ment, have a broad sensorimotor distribution unexplained by lumbar imaging findings, hyperreflexia/patho- logical reflexes, or other atypical findings (eg, negative neural tension tests). In such cases, MRI of the cervical and thoracic spine may be indicated. Eric Chun-Pu Chu, Robert J Trager (2022) Thoracic Schwannoma as an Unusual Cause of Sciatic Pain in the Chiropractic Office: A Case Report American Journal of Case Reports 23: e938448. October. http://dx.doi.org/10.12659/AJCR.938448 Chiropractic, Low Back Pain, #Neurilemmoma