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Okubo T, Fujiyoshi K, Kobayashi Y, Matsubayashi K, Konomi T, Furukawa M, Asazuma T, Yato Y. Does the degree of preoperative gait disturbance remain after tumor resection in patients with intradural extramedullary spinal cord tumors? Spinal Cord 2023; 61:637-643. [PMID: 37640925 DOI: 10.1038/s41393-023-00931-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVE This study aimed to determine whether the degree of preoperative gait disturbance remains following surgical resection in patients with intradural extramedullary spinal cord tumors (IDEMSCTs), and to investigate any factors that may influence poor improvement in postoperative gait disturbance. SETTING The single institution in Japan. METHODS In total, 78 IDEMSCTs patients who required surgical excision between 2010 and 2019 were included. According to the degree of preoperative gait disturbance using modified McCormick scale (MMCS) grade, they were divided into the Mild and Severe groups. The mean postoperative follow-up period was 50.7 ± 17.9 months. Data on demographic and surgical characteristics were compared between the two groups. RESULTS There was no significant difference in terms of age at surgery, sex, tumor size, surgical time, estimated blood loss, tumor histopathology, and postoperative follow-up period between the Mild and Severe groups. At the final follow-up, 84.6% of IDEMSCTs patients were able to walk without support. Gait disturbance improved after surgery in most of the patients with preoperative MMCS grades II-IV, but remained in approximately half of patients with preoperative MMCS grade V. Age at surgery was correlated with poor improvement in postoperative gait disturbance in the Severe group. CONCLUSIONS Regardless of the degree of preoperative gait disturbance, it improved after tumor resection in most of the IDEMSCTs patients. However, in the preoperative MMCS grade III-V cases, older age at surgery would be an important factor associated with poor improvement in postoperative gait disturbance.
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Affiliation(s)
- Toshiki Okubo
- Department of Orthopaedics Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan.
| | - Kanehiro Fujiyoshi
- Department of Orthopaedics Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
| | - Yoshiomi Kobayashi
- Department of Orthopaedics Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
| | - Kohei Matsubayashi
- Department of Orthopaedics Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
| | - Tsunehiko Konomi
- Department of Orthopaedics Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
| | - Mitsuru Furukawa
- Department of Orthopaedics Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
| | - Takashi Asazuma
- Department of Orthopaedics Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
| | - Yoshiyuki Yato
- Department of Orthopaedics Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
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Gojsevic M, Shariati S, Chan AW, Bonomo P, Zhang E, Kennedy SKF, Rajeswaran T, Rades D, Vassiliou V, Soliman H, Lee SF, Wong HCY, Rembielak A, Oldenburger E, Akkila S, Azevedo L, Chow E. Quality of life in patients with malignant spinal cord compression: a systematic review. Support Care Cancer 2023; 31:736. [PMID: 38055061 DOI: 10.1007/s00520-023-08186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Malignant spinal cord compression (MSCC) is an oncological emergency that may result in a devastating combination of malignancy and disability. Existing quality of life (QoL) questionnaires commonly used in MSCC literature (EORTC QLQ-C30, BM-22, Brief Pain Inventory, and Spine Oncology Study Group Outcomes) may not capture all the commonly reported symptoms and lack specificity to MSCC. The primary objective of this systematic review is to determine unmet patient needs and underreported QoL issues and compile a comprehensive list of QoL issues. The secondary objective of this review is to compile all existing QoL tools and questionnaires and determine whether any QoL issues are not addressed in the existing tools currently used in the literature. METHODS A literature search was conducted on Ovid MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases between 1946 and February 6, 2023, to compile all QoL issues and existing questionnaires used to assess QoL in patients with MSCC. All study designs were included given that they discussed QoL issues specific to patients with MSCC. RESULTS The results of this systematic review identified the most frequently discussed QoL issues in the literature studying MSCC. This included direct symptoms of MSCC such as back pain, paralysis, limb weakness/numbness, and urinary/bowel incontinence. Indirect symptoms coming from radiotherapy treatment such as dysphagia, painful swallowing, mouth pain, dry mouth, diarrhea, fatigue, and nausea/vomiting were also noted. Other symptoms resulting from corticosteroid treatment included difficulty sleeping, blurring of vision, weight gain, and mood disturbance. Patients also experienced psychosocial issues such as anxiety, depression, emotional distress, low self-esteem, concerns about dependence on others, concerns about getting home, and fear about their prognosis and future. CONCLUSION This review highlights the QoL issues specific to patients with MSCC and QoL tools capturing these issues. Relevance of QoL issues identified in this systematic review must be prospectively validated by patients and healthcare professionals with experience in treating MSCC.
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Affiliation(s)
- Milena Gojsevic
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Saba Shariati
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Elwyn Zhang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Samantha K F Kennedy
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Thenugaa Rajeswaran
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - Hany Soliman
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Shing-Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong, Hong Kong
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Agata Rembielak
- The University of Manchester, Manchester, UK
- Department of Clinical Oncology, The Christie NHS Foundation Trust and the University of Manchester, Manchester, UK
| | - Eva Oldenburger
- Department of Radiation Oncology, University Hospitals Leuven, Louvain, Belgium
| | - Shereen Akkila
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
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Nakarai H, Kato S, Yamato Y, Kodama H, Ohba Y, Sasaki K, Iizuka T, Tozawa K, Urayama D, Komatsu N, Okazaki R, Oshina M, Ogiso S, Masuda K, Maayan O, Tanaka S, Oshima Y. Quality of Life and Postoperative Satisfaction in Patients with Benign Extramedullary Spinal Tumors: A Multicenter Study. Spine (Phila Pa 1976) 2023; 48:E308-E316. [PMID: 37417695 DOI: 10.1097/brs.0000000000004771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
STUDY DESIGN Retrospective cohort study using prospectively collected registry data. OBJECTIVE The purpose of this study is to evaluate health-related quality of life (HRQOL) and postoperative satisfaction in patients with different histotypes of benign extramedullary spinal tumors (ESTs). BACKGROUND Little is known about how different histotypes influence HRQOL and postoperative satisfaction in EST patients. MATERIALS AND METHODS Patients undergoing primary benign EST surgery at 11 tertiary referral hospitals between 2017 and 2021 who completed preoperative and 1-year postoperative questionnaires were included. HRQOL assessment included the Physical Component Summary and Mental Component Summary (MCS) of Short Form-12, EuroQol 5-dimension, Oswestry/Neck Disability Index (ODI/NDI), and Numeric Rating Scales (NRS) for upper/lower extremities (UEP/LEP) and back pain (BP). Patients who answered "very satisfied," "satisfied," or "somewhat satisfied" on a seven-point Likert scale were considered to be satisfied with treatment. Student t -tests or Welch's t -test were used to compare continuous variables between two groups, and one-way analysis of variance was used to compare outcomes between the three groups of EST histotypes (schwannoma, meningioma, atypical). Categorical variables were compared using the χ 2 test or Fisher exact test. RESULTS A total of 140 consecutive EST patients were evaluated; 100 (72%) had schwannomas, 30 (21%) had meningiomas, and 10 (7%) had other ESTs. Baseline Physical Component Summary was significantly worse in patients with meningiomas ( P =0.04), and baseline NRS-LEP was significantly worse in patients with schwannomas ( P =0.03). However, there were no significant differences in overall postoperative HRQOL or patient satisfaction between histology types. Overall, 121 (86%) patients were satisfied with surgery. In a subgroup analysis comparing intradural schwannomas and meningiomas adjusted for patient demographics and tumor location with inverse probability weighting, schwannoma patients had worse baseline MCS ( P =0.03), ODI ( P =0.03), NRS-BP ( P <.001), and NRS-LEP ( P =0.001). Schwannoma patients also had worse postoperative MCS ( P =0.03) and NRS-BP ( P =0.001), with no significant difference in the percentage of satisfied patients ( P =0.30). CONCLUSIONS Patients who underwent primary benign EST resection had a significant improvement in HRQOL postoperatively, and ~90% of these patients reported being satisfied with their treatment outcomes one year after surgery. EST patients may exhibit a relatively lower threshold for postoperative satisfaction compared with patients undergoing surgery for degenerative spine conditions.
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Affiliation(s)
- Hiroyuki Nakarai
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
| | - So Kato
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukimasa Yamato
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyasu Kodama
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yutaro Ohba
- Department of Orthopedic Surgery, Kanto Rosai Hospital, Kanagawa, Japan
| | - Katsuyuki Sasaki
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Tetsusai Iizuka
- Department of Orthopedic Surgery, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Keiichiro Tozawa
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Spine center, Toranomon Hospital, Tokyo, Japan
| | - Daiki Urayama
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Spinal Surgery, Japan Community Health-care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Naoto Komatsu
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Rentaro Okazaki
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Saitama Red Cross Hospital, Saitama, Japan
| | - Masahito Oshina
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Sawako Ogiso
- Department of Orthopedic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Kazuhiro Masuda
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Omri Maayan
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasushi Oshima
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Hersh AM, Lubelski D, Theodore N, Sciubba DM, Jallo G, Shimony N. Approaches to Incidental Intradural Tumors of the Spine in the Pediatric Population. Pediatr Neurosurg 2023; 58:367-378. [PMID: 36948181 DOI: 10.1159/000530286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/10/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Incidental intradural tumors of the spine in the pediatric population are rare lesions whose management remains unclear. Surgeons must balance the risks of iatrogenic deficits and complications after surgical resection against the risks from progressive growth of the tumor. Moreover, the natural history of an incidental finding can be difficult to predict. Here, we review the literature on incidental intradural tumors of the spine and present considerations for their management. SUMMARY Growth of the tumor or changes in radiographic features are usually indications for resection. Asymptomatic lesions can be found in patients with genetic syndromes that predispose to tumor formation, such as neurofibromatosis type 1 and 2, schwannomatosis, and Von-Hippel-Lindau syndrome, and careful workup of a genetic cause is warranted in any patient presenting with multiple tumors and/or cutaneous features. Close follow-up is generally favored given the heavy tumor burden; however, some recommend pre-emptive resection to prevent permanent neurological deficits. Incidental intradural tumors can also occur in association with hydrocephalus, significant syringomyelia, and cord compression, and surgical treatment is usually warranted. Tumors may also be discovered as part of the workup for scoliosis, where they are not truly incidental to the scoliosis but rather are contributing to curve deformation. KEY MESSAGES Thorough workup of patients for associated genetic syndromes or comorbidities should be undertaken in pediatric patients with incidental intradural tumors. Further research is needed into the natural history of these incidental lesions. Incidental tumors can often be managed conservatively with close follow-up, with surgical intervention warranted for expanding tumors or new-onset symptoms.
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Affiliation(s)
- Andrew M Hersh
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA,
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Manhasset, New York, USA
| | - George Jallo
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Neurosurgery, Johns Hopkins Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Nir Shimony
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Semmes-Murphey clinic, Memphis, Tennessee, USA
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Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15030591. [PMID: 36765547 PMCID: PMC9913127 DOI: 10.3390/cancers15030591] [Citation(s) in RCA: 69] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Experiencing pain and insufficient relief can be devastating and negatively affect a patient's quality of life. Developments in oncology such as new treatments and adjusted pain management guidelines may have influenced the prevalence of cancer pain and severity in patients. This review aims to provide an overview of the prevalence and severity of pain in cancer patients in the 2014-2021 literature period. A systematic literature search was performed using the databases PubMed, Embase, CINAHL, and Cochrane. Titles and abstracts were screened, and full texts were evaluated and assessed on methodological quality. A meta-analysis was performed on the pooled prevalence and severity rates. A meta-regression analysis was used to explore differences between treatment groups. We identified 10,637 studies, of which 444 studies were included. The overall prevalence of pain was 44.5%. Moderate to severe pain was experienced by 30.6% of the patients, a lower proportion compared to previous research. Pain experienced by cancer survivors was significantly lower compared to most treatment groups. Our results imply that both the prevalence of pain and pain severity declined in the past decade. Increased attention to the assessment and management of pain might have fostered the decline in the prevalence and severity of pain.
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Haußmann A. [Spinal neoplasms]. Radiologe 2021; 61:1031-1042. [PMID: 34661684 DOI: 10.1007/s00117-021-00922-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/28/2022]
Abstract
Spinal neoplasms are generally rare disorders but play an important role in the differential diagnosis of space-occupying masses of the spinal axis. Although there are several different classification criteria (histological origin, dignity, positional relationship to the spine), the standard classification of spinal neoplasms based on the relationship to the dura mater into extraspinal, intraspinal extramedullary and intraspinal intramedullary is used. Magnetic resonance imaging is the gold standard for the morphological imaging of spinal neoplasms, followed by computed tomography. In addition to localization and symptoms, the patient's age is essential with respect to the diagnosis of the possible tumor entity.
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Affiliation(s)
- Alena Haußmann
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Str., Geb. 90, 66421, Homburg/Saar, Deutschland.
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Malignant Melanotic Schwannian Tumor Presenting with Spinal Cord Infarction Due to Occlusion of the Artery of Adamkiewicz: Case Report and Review of the Literature. World Neurosurg 2019; 128:422-425. [PMID: 31108251 DOI: 10.1016/j.wneu.2019.04.267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Malignant melanotic schwannian tumors (MMSTs) are rare peripheral nerve sheath tumors that typically exhibit benign clinical presentation and histopathology but malignant long-term behavior. CASE DESCRIPTION We report a case of a 22-year-old male with a T9-11 MMST who presented with acute paraplegia and complete loss of sacral function. Despite emergent decompression, he did not recover motor, sensory or bladder function, although bowel function did normalize. CONCLUSIONS The anatomic location and rapid presentation of permanent deficits are suggestive of infarction of the spinal cord supplied by the artery of Adamkiewicz, a rare presentation of this disorder and of spinal schwannomas in general.
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Liu Y, Wang B, Qian Y, Di D, Wang M, Zhang X. Cauda equine syndrome as the primary symptom of leptomeningeal metastases from lung cancer: a case report and review of literature. Onco Targets Ther 2018; 11:5009-5013. [PMID: 30174438 PMCID: PMC6109657 DOI: 10.2147/ott.s165299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cauda equine syndrome (CES) is a neurological condition caused by compression of the cauda equine. Here, we demonstrate a case of CES as the primary symptom of leptomeningeal metastases from non-small cell lung carcinoma without brain metastases. A 59-year-old male suffered progressive lower extremity motor dysfunction, urinary dysfunction, and lower extremity sensory dysfunction. He was clinically diagnosed with CES. Nuclear magnetic resonance imaging demonstrated several vague nodules in the area of conus medullaris and cauda equine, without lumbar or thoracic herniated discs. The serum carcinoembryonic antigen concentration was 191.20 ng/mL. The conclusion following positron emission tomography–computed tomography was a right upper lung malignant tumor with mediastinal lymph node metastasis and cauda equina metastasis. Pathologic diagnosis was of primary adenocarcinoma of the lung by bronchoscopic biopsy. EML4–ALK fusion and EGFR mutations were absent, and thus the patient received chemotherapy. However, symptoms of intracranial hypertension arose 1 month later, and the patient died 3 months postadmission. Emerging CES may be a sign of metastasis of a malignant tumor, presenting an extremely challenging condition, especially for patients with lung cancer. Positron emission tomography–computed tomography is a fairly effective technique to make the diagnosis.
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Affiliation(s)
- Yang Liu
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China,
| | - Bin Wang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China,
| | - Yongxiang Qian
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China,
| | - Dongmei Di
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China,
| | - Min Wang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China,
| | - Xiaoying Zhang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China,
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Thoracic Schwannoma in an Adult Male Presenting With Thoracic Pain: A Case Report. J Chiropr Med 2017; 16:242-245. [PMID: 29097955 DOI: 10.1016/j.jcm.2017.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 11/22/2022] Open
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.
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