Disclosures: Ramapaada R. Medam: No financial relationships or conflicts of interest

Case Diagnosis: A 59-year-old female with chronic middle and low back pain for 20+ years and occasional bladder incontinence.

Case Description or Program Description: She has low back pain localized to the right side below the belt line that is characterized as dull with occasional sharp pains that are both axial and radicular. Her low back pain is managed with radiofrequency ablation (RFA). She also has mid back pain which she describes as “muscle spasms.” Trigger points injections (TPI) relieve her mid back pain for about two to three months at a time. Recurrent chronic pain despite intervention warranted workup via MRI to determine the root cause.

Setting: Private practice.

Assessment/Results: MRI of the lumbar spine without contrast revealed a 4mm lesion along the cauda equina at the level of L2-L3, so repeat imaging with contrast was recommended. MRI of the lumbar spine with contrast detailed a homogenously enhancing 4mm lesion along the cauda equina on the right side at the level of L2-L3 without any other intramedullary lesions or abnormal enhancement or lesions within the vertebral bodies. Based on these findings, the most likely cause of her symptoms is a schwannoma of the cauda equina. Management will consist of observation and conservative pain management approaches included RFA and TPI, with consideration of gross surgical resection if symptoms continue to progress.

Discussion (relevance): Schwannomas often stem from the dorsal sensory roots, so patients commonly present with pain and radicular symptoms rather than motor changes. Although schwannomas are often benign and grow slowly, over time they can compress structures which can disrupt neuronal transmission. Patients with a schwannoma of the cauda equina often present with progressive lower extremity radiculopathy and sphincter dysfunction. Gross surgical resection is the current standard to avoid lesion recurrence.

Conclusions: Schwannoma of the cauda equina should be considered as a potential etiology of chronic progressive radicular pain and bladder incontinence.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/diagnosis-and-management-of-an-l2-l3-schwannoma-a-case-report/