Neoplastic malignant cord compression mimicking low back pain: A case report.
cauda equina syndrome
differential diagnosis
low back pain
malignancy
physiotherapy
Journal
Physiotherapy research international : the journal for researchers and clinicians in physical therapy
ISSN: 1471-2865
Titre abrégé: Physiother Res Int
Pays: United States
ID NLM: 9612022
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
revised:
22
07
2022
received:
18
03
2022
accepted:
28
08
2022
pubmed:
8
9
2022
medline:
4
1
2023
entrez:
7
9
2022
Statut:
ppublish
Résumé
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. 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. 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.
Sections du résumé
BACKGROUND
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
METHODS
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
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.
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1971Informations de copyright
© 2022 John Wiley & Sons Ltd.
Références
Brindisino, F., Passudetti, V., Pennella, D., Giovannico, G., & Heick, J. D. (2022). Recognition of pulmonary pathology in a patient presenting with shoulder pain. Physiotherapy Theory and Practice, 38(4), 597-607. https://doi.org/10.1080/09593985.2020.1768611
Chiarotto, A., Maxwell, L. J., Ostelo, R. W., Boers, M., Tugwell, P., & Terwee, C. B. (2019). Measurement properties of visual analogue Scale, numeric rating Scale, and pain severity subscale of the brief pain inventory in patients with low back pain: A systematic review. The Journal of Pain, 20(3), 245-263. https://doi.org/10.1016/j.jpain.2018.07.009
DePalma, M. G. (2020). Red flags of low back pain. Jaapa, 33(8), 8-11. https://doi.org/10.1097/01.JAA.0000684112.91641.4c
Fatoye, F., Gebrye, T., & Odeyemi, I. (2019). Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatology International, 39(4), 619-626. https://doi.org/10.1007/s00296-019-04273-0
Finucane, L. M., Downie, A., Mercer, C., Greenhalgh, S. M., Boissonnault, W. G., Pool-Goudzwaard, A. L., Beneciuk, J. M., Leech, R. L., & Selfe, J. (2020). International framework for red flags for potential serious spinal pathologies. Journal of Orthopaedic & Sports Physical Therapy, 50(7), 350-372. https://doi.org/10.2519/jospt.2020.9971
Gagnier, J. J., Kienle, G., Altman, D. G., Moher, D., Sox, H., & Riley, D. (2013). The CARE guidelines: Consensus-based clinical case reporting guideline development. Headache, 53(10), 1541-1547. https://doi.org/10.1111/head.12246
Giovannico, G., Brindisino, F., Pappaccogli, M., Saltalamacchia, A., Bonetti, F., Tavarnelli, M., Mezzetti, M, & Delitto, A. (2020). A description of physical therapists’ knowledge in basic competence examination of musculoskeletal conditions: An Italian national cross-sectional survey. Muscles, Ligaments and Tendons Journal, 10(4), 686-697. https://doi.org/10.32098/mltj.04.2020.17
Greenhalgh, S., Finucane, L., Mercer, C., & Selfe, J. (2018). Assessment and management of cauda equina syndrome. Musculoskeletal Science & Practice, 37, 69-74. https://doi.org/10.1016/j.msksp.2018.06.002
Hoy, D., March, L., Brooks, P., Blyth, F., Woolf, A., Bain, C., Williams, G., Smith, E., Vos, T., Barendregt, J., Murray, C., Burstein, R., & Buchbinder, R. (2014). The global burden of low back pain: Estimates from the global burden of disease 2010 study. Annals of the Rheumatic Diseases, 73(6), 968-974. https://doi.org/10.1136/annrheumdis-2013-204428
Italian Ministry of Health. (1994). DECRETO 14 settembre 1994, n. 741.
Koes, B. W., van Tulder, M., Lin, C. W., Macedo, L. G., McAuley, J., & Maher, C. (2010). An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. European Spine Journal, 19(12), 2075-2094. https://doi.org/10.1007/s00586-010-1502-y
Maselli, F., Palladino, M., Barbari, V., Storari, L., Rossettini, G., & Testa, M. (2020). The diagnostic value of red flags in thoracolumbar pain: A systematic review. 1-17. https://doi.org/10.1080/09638288.2020.1804626
Maselli, F., & Testa, M. (2019). Superficial peroneal nerve schwannoma presenting as lumbar radicular syndrome in a non-competitive runner. Journal of Back and Musculoskeletal Rehabilitation, 32(2), 361-365. https://doi.org/10.3233/bmr-181164
Maselli, F. P. D., Cataldi, F., Albertoni, D., Ciuro, A., & Aldo, C. (2016). Nonspecific Low Back Pain (LBP) can occult a serious pathology: Case report of Multiple Sclerosis (MS) in a young patient. Acta Medica, 3(1), 202. https://doi.org/10.5530/ami.2016.1.40
Mesner, S. A., Foster, N. E., & French, S. D. (2016). Implementation interventions to improve the management of non-specific low back pain: A systematic review. BMC Musculoskeletal Disorders, 17(1), 258. https://doi.org/10.1186/s12891-016-1110-z
Mourad, F., Giovannico, G., Maselli, F., Bonetti, F., Fernández de las Peñas, C., & Dunning, J. (2016). Basilar impression presenting as intermittent mechanical neck pain: A rare case report. BMC Musculoskeletal Disorders, 17(1), 7. https://doi.org/10.1186/s12891-015-0847-0
Mourad, F., Maselli, F., Cataldi, F., Pennella, D., Fernández-De-Las-Peñas, C., & Dunning, J. (2020). Hip bone marrow edema presenting as low back pain: A case report. Physiotherapy Theory and Practice, 36(1), 249-257. https://doi.org/10.1080/09593985.2018.1481163
Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: A systematic review. BMJ Open, 8(8), e022202. https://doi.org/10.1136/bmjopen-2018-022202
Ojha, H. A., Snyder, R. S., & Davenport, T. E. (2014). Direct access compared with referred physical therapy episodes of care: A systematic review. Physical Therapy, 94(1), 14-30. https://doi.org/10.2522/ptj.20130096
Oliveira, C. B., Maher, C. G., Pinto, R. Z., Traeger, A. C., Lin, C. W. C., Chenot, J. F., van Tulder, M., & Koes, B. W. (2018). Clinical practice guidelines for the management of non-specific low back pain in primary care: An updated overview. European Spine Journal, 27(11), 2791-2803. https://doi.org/10.1007/s00586-018-5673-2
Pendergast, J., Kliethermes, S. A., Freburger, J. K., & Duffy, P. A. (2012). A comparison of health care use for physician-referred and self-referred episodes of outpatient physical therapy. Health Services Research, 47(2), 633-654. https://doi.org/10.1111/j.1475-6773.2011.01324.x
Pennella, D., Giagio, S., Maselli, F., Giovannico, G., Roncone, A., Fiorentino, F., & Brindisino, F. (2022). Red flags useful to screen for gastrointestinal and hepatic diseases in patients with shoulder pain: A scoping review. Musculoskeletal Care. https://doi.org/10.1002/msc.1628
Premkumar, A., Godfrey, W., Gottschalk, M. B., & Boden, S. D. (2018). Red flags for low back pain are not always really red: A prospective evaluation of the clinical utility of commonly used screening questions for low back pain. The Journal of Bone and Joint Surgery. American Volume, 100(5), 368-374. https://doi.org/10.2106/jbjs.17.00134
Ross, M. D., & Boissonnault, W. G. (2010). Red flags: To screen or not to screen? Journal of Orthopaedic & Sports Physical Therapy, 40(11), 682-684. https://doi.org/10.2519/jospt.2010.0109
Todd, N. V. (2017). Guidelines for cauda equina syndrome. Red flags and white flags. Systematic review and implications for triage. British Journal of Neurosurgery, 31(3), 336-339. https://doi.org/10.1080/02688697.2017.1297364
van Tulder, M., Becker, A., Bekkering, T., Breen, A., del Real, M. T., Hutchinson, A., Koes, B., Laerum, E., & Malmivaara, A. (2006). Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. European Spine Journal, 15(Suppl 2), S169-S191. https://doi.org/10.1007/s00586-006-1071-2
Verhagen, A. P., Downie, A., Popal, N., Maher, C., & Koes, B. W. (2016). Red flags presented in current low back pain guidelines: A review. European Spine Journal, 25(9), 2788-2802. https://doi.org/10.1007/s00586-016-4684-0