Neoplastic malignant cord compression mimicking low back pain: A case report

Abstract

Background: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.Case presentation: 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. Conclusions: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. K E Y W O R D Scauda equina syndrome, differential diagnosis, low back pain, malignancy, physiotherapy | BACKGROUNDLow Back Pain (LBP) is a common condition, affecting 50%-80% of adults in their lifetime (Hoy et al., 2014;Koes et al., 2010;Oliveira & Maher, 2018). It has recently been identified as the most important cause of disability (Mesner et al., 2016) and remains a common condition among primary care patients, with an estimated lifetime prevalence of 13.8% for chronic pain and 80% for any episode of pain (Verhagen et al., 2016).European guidelines on the management of LBP in primary care define LBP as ''pain and discomfort localized below the costal margin and above the inferior gluteal folds, with or without leg pain'' (van Tulder et al., 2006). Non-specific LBP, commonly defined as LBP without any known cause (van Tulder et al., 2006), is diagnosed in about 90% of cases, due to unidentifiable underlying musculoskeletal causes (Fatoye et al., 2019;Koes et al., 2010;Oliveira & Maher, 2018). Patients with LBP may have neurological impairments, such as radiculopathy and neurological disorders, or a serious

Tumour Hidden behind Thoracic Spine Pain: A Rare Case of Neuroblastoma in a Young Mother—A Case Report

“…Moreover, it could be necessary for health professionals to be trained in “inductive reasoning or pattern recognition”—which consists of formulating hypotheses after observing data and identifying some patterns attributable to specific pathological pictures and contributing factors [ 32 ]. Unfortunately, sometimes patients are referred to physiotherapists, but they are out of the physical therapy scope of practice [ 33 , 34 , 35 ]. For this reason, it is important for physiotherapists to perform a comprehensive anamnestic collection for each patient and to always screen for red flags, in order to understand if the patient must be treated, treated and referred, or referred [ 31 ].…”

Aggressive Vertebral Hemangioma and Spinal Cord Compression: A Particular Direct Access Case of Low Back Pain to Be Managed—A Case Report

“…In accordance with clinical guidelines [ 25 ], LBP is usually considered a musculoskeletal disorder with a positive prognosis, commonly treated by PTs using education, manual therapy and exercises. However, in a low percentage of cases, LBP may result from an extra-physiotherapeutic pathology, such as neoplasm, infections, cauda equina syndrome or fractures [ 14 , 26 ].…”