Elvis Guzman, M.D.
Resident
Memorial Healthcare System
Hollywood, Florida, United States
Robert Klecz, MD
Physiatrist
Memorial Healthcare System
Hollywood, Florida, United States
A 77-year-old male with a five-year history of low back pain presented with complaints of bilateral lower limb weakness, numbness, and recurrent falls. The symptoms had progressed over the last two years despite therapy efforts and analgesics. He denied bowel or bladder incontinence. Physical examination revealed intact muscle strength but hypoesthesia in the distal lower limbs, hyperreflexia (3+) in the lower extremities, and a positive Romberg sign with moderate sway. Neuroimaging uncovered a 15 x 14 x 25 mm intradural-extramedullary mass at the T10-T11 level, resulting in significant spinal cord compression. The patient's cord was paper-thin, placing him at high risk for paralysis with or without trauma. He subsequently underwent T9-T12 laminectomies for mass resection, leading to marked improvements in his low back pain and neurological function, requiring supervision ambulating 200 meters without assistive device.
Discussions:
Spinal cord compression without trauma can often be misdiagnosed, particularly when initial symptoms, such as low back pain, mimic common degenerative changes like lumbar spondylosis. In this case, a thoracic schwannoma masqueraded as a benign lumbar spine issue, delaying the appropriate intervention. A lack of early recognition and proper imaging in such cases can result in progressive and potentially irreversible neurological deficits. Given the patient’s severe cord compression, timely surgical decompression was critical in preventing paralysis and restoring function.
Conclusions:
This case emphasizes the importance of early diagnosis in preventing long-term neurological damage in patients with spinal cord compression. Clinicians must maintain a high index of suspicion when evaluating patients with chronic back pain and gait disturbances, as delayed diagnosis may result in permanent deficits. Thorough imaging and prompt intervention are essential for optimal patient outcomes.
