Abstract
Intradural tumours of the spine are usually benign and have a good prognosis, if they are diagnosed and removed early. Lumbar disc herniation is a common cause of chronic, acute, or recurrent lumbar radiculopathy. However, to date, there have been no reports of progressive neurological deficiencies due to the co-existence of two significant pathologies contributing to intradural and extradural compression. The current study reports the rare case of a patient with simultaneous extradural and intradural compression of the nerve root due to co-existent intervertebral disc herniation and an intradural schwannoma at the same level. A 71-year-old female suffering from lower back pain and radiating pain of the right lower extremities was admitted to Busan Korea Hospital (Busan, Korea). Magnetic resonance imaging revealed lumbar disc herniation at L4–5 and a mass occupying the intradural space at the same level of the compressed dural sac. Using the posterior approach, surgical excision of the two pathologies was performed. Pathological diagnosis confirmed schwannoma and the symptoms markedly improved.
Highlights
Lumbar disc herniation is the most common cause of lumbar radiculopathy [1]
Schwannomas are slow‐growing, benign, encapsulated tumors that originate from the Schwann cells in the myelin sheath of nerve fibers [4]
Schwannomas are generally single tumors and account for 26% of all intraspinal tumors that involve the lumbar spinal nerves
Summary
Lumbar disc herniation is the most common cause of lumbar radiculopathy [1]. The majority of patients with lumbar disc herniation respond to conservative treatment, but for those with persistent or progressive symptoms of nerve root compression, surgical treatment must be considered [2,3]. Schwannomas are generally single tumors and account for 26% of all intraspinal tumors that involve the lumbar spinal nerves. They are usually benign, but can be locally aggressive and cause neurological compromise [5]. The results of the straight leg‐raising test were 40 ̊/70 ̊ and the Patrick's test results were normal These observations led to a suspected diagnosis of a rapidly growing tumor with right L5 radiculopathy. Follow‐up MRI scan revealed lumbar disc herniation compressing the thecal sac and right neural foramen at L4/5, and an intradural structure at the same level (Fig. 2). Residual abnormal sensation on the skin of the left buttock, which did not affect the patient's normal active life style
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