Caputo L A, Cusimano M D
Department of Graduate Studies and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
J Manipulative Physiol Ther. 1997 Feb;20(2):124-9.
To review the features of spinal schwannoma in a case that mimicked a lumbar disc herniation.
A 37-yr-old woman suffered from a 4-yr history of progressive low back and leg pain, with progressive neurological involvement of several nerve roots. Noteworthy symptomatology included increased pain when lying recumbent and urinary and fecal incontinence. Several health care practitioners diagnosed her with a lumbar disc herniation. Investigations with myelography, computed tomography (CT) with myelographic contrast and magnetic resonance imaging (MRI) revealed the presence of an intradural tumor at the T12-L2 region.
The tumor was surgically resected via laminectomies at T12-L2. The patient experienced a decrease of pain intensity but continued to complain about the low back and posterior thigh pain and has been unable to return to work. She continues to suffer from urinary incontinence, which is controlled by medication. There has been no recurrence of the tumor.
Spinal pathology such as schwannoma of the cauda equina can mimic common complaints of low back pain seen in clinical practice. Differentiating features of cauda equina tumors from lumbar disc prolapse include: pain on lying recumbent, progressive nature of the pain and neurological deficit, involvement of several nerve root levels and intractability of the condition to conservative therapy. The most appropriate methods for imaging these tumors are CT with myelography or MRI. Patient prognosis is improved with early detection and removal. Chiropractors can play a pivotal role in the care of these patients by being suspicious of patients who do not respond as expected to a course of manipulative therapy, by investigating or referring appropriately and by aiding in active rehabilitation postoperatively.
回顾一例酷似腰椎间盘突出症的脊髓神经鞘瘤的特征。
一名37岁女性有4年进行性腰腿痛病史，伴有多个神经根的进行性神经受累。值得注意的症状包括平卧时疼痛加剧以及大小便失禁。多位医护人员诊断她为腰椎间盘突出症。脊髓造影、脊髓造影增强计算机断层扫描（CT）和磁共振成像（MRI）检查显示在T12 - L2区域存在硬膜内肿瘤。
通过T12 - L2椎板切除术对肿瘤进行手术切除。患者疼痛强度有所减轻，但仍抱怨下背部和大腿后部疼痛，且无法重返工作岗位。她仍患有尿失禁，通过药物控制。肿瘤未复发。
马尾神经鞘瘤等脊髓病变可酷似临床实践中常见的腰痛主诉。马尾神经肿瘤与腰椎间盘突出症的鉴别特征包括：平卧时疼痛、疼痛的进行性性质和神经功能缺损、多个神经根水平受累以及病情对保守治疗的难治性。对这些肿瘤进行成像的最合适方法是脊髓造影CT或MRI。早期发现并切除可改善患者预后。脊椎按摩师在这些患者的护理中可发挥关键作用，即对未按预期对手法治疗疗程做出反应的患者保持怀疑，进行适当的调查或转诊，并协助术后积极康复。
