Cataldi Fabio, Brindisino Fabrizio, Angilecchia Domenico, Andreani Alessandro, Giovannico Giuseppe
University "Tor Vergata", Faculty of Medicine, Roma, Italy.
Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
Physiother Res Int. 2023 Jan;28(1):e1971. doi: 10.1002/pri.1971. Epub 2022 Sep 6.
The point prevalence of Cauda Equina Syndrome (CES) as a cause of Low Back Pain (LBP) is estimated at 0.04% in primary care, and it is reported as a complication in about 2% of patients with disc herniation. Compression of the cauda equina usually occurs as a result of disc prolapse. However, CES may be caused by any space-occupying lesion, including spinal stenosis, neoplasms, cysts, infection, and osteophytes. First contact physiotherapists may encounter patients with early CES, as the clinical presentation of CES can mimic non-specific LBP.
This case report presents the medical history, diagnostic tests and relevant clinical data of a 52-year-old man complaining of LBP. The patient's medical history, his symptoms and the clinical findings led to the identification of a number of red flags (i.e. risk factors) suggestive of a non-musculoskeletal condition. The patient was referred to the emergency department for further investigation. Having undergone several diagnostic tests, the patient was diagnosed with CES due to malignancy.
This case report highlights the importance of differential screening throughout the treatment period, in order to identify red flags that warrant further investigation and a referral to an appropriate specialist. Physiotherapy screening should include clinical reasoning, careful analysis of clinical presentation and symptom progression, in addition to appropriate referral for medical assessment and diagnostic imaging, if necessary.
在初级医疗保健中，马尾综合征（CES）作为腰痛（LBP）病因的时点患病率估计为0.04%，据报道，在约2%的椎间盘突出症患者中，它是一种并发症。马尾受压通常是椎间盘脱垂的结果。然而，CES可能由任何占位性病变引起，包括椎管狭窄、肿瘤、囊肿、感染和骨赘。首次接触患者的物理治疗师可能会遇到早期CES患者，因为CES的临床表现可能类似于非特异性腰痛。
本病例报告介绍了一名52岁男性腰痛患者的病史、诊断检查及相关临床资料。患者的病史、症状和临床检查结果提示了一些警示信号（即危险因素），表明可能存在非肌肉骨骼疾病。该患者被转诊至急诊科进行进一步检查。经过多项诊断检查，患者被诊断为因恶性肿瘤导致的CES。
本病例报告强调了在整个治疗期间进行鉴别筛查的重要性，以便识别需要进一步检查并转诊至合适专科医生的警示信号。物理治疗筛查应包括临床推理、对临床表现和症状进展的仔细分析，必要时还应进行适当的转诊以便进行医学评估和诊断成像检查。
