Shawn P Williams1, Bernard Beckerman1, Maria Elena Piña Fonti2. 1. Associate Professor, Department of Health Professions, CUNY, York College, Jamaica, NY. 2. President, Nightingale Medical Supply Company Inc., Queens, NY.
Abstract
OBJECTIVE: The purpose of this case report is to describe the presentation of a patient with lumbosacral chordoma characterized by somatic chronic low back pain and intermittent sacral nerve impingement. CASE REPORT: A 69-year-old male presenting to an emergency department (ED) with low back pain was provided analgesics and muscle relaxants then referred for a series of chiropractic treatments. Chiropractic treatment included manipulation, physical therapy, and rehabilitation. After 3 times per week for a total of 4 weeks, re-examination showed little relief of his symptoms. His pain symptoms worsened and he presented to the ED for the second time. Magnetic resonance imaging was performed and revealed a high intensity mass. INTERVENTION AND OUTCOME: The soft tissue mass identified on magnetic resonance imaging was surgically removed. Shortly after the surgery, the patient developed post-operative bleeding and was returned to surgery. During the second procedure, he developed a post-operative hemorrhage related to the development of disseminated intravascular coagulation and subsequently died during the second procedure. A malignant lumbosacral chordoma was diagnosed on pathologic examination. CONCLUSION: This case report describes the presentation of a patient with lumbosacral chordoma presenting with musculoskeletal low back pain. Chordomas are rare with few prominent manifestations. An early diagnosis can potentially make a difference in morbidity and mortality. Due to its insidious nature, it is a difficult diagnosis and one that is often delayed.
OBJECTIVE: The purpose of this case report is to describe the presentation of a patient with lumbosacral chordoma characterized by somatic chronic low back pain and intermittent sacral nerve impingement. CASE REPORT: A 69-year-old male presenting to an emergency department (ED) with low back pain was provided analgesics and muscle relaxants then referred for a series of chiropractic treatments. Chiropractic treatment included manipulation, physical therapy, and rehabilitation. After 3 times per week for a total of 4 weeks, re-examination showed little relief of his symptoms. His pain symptoms worsened and he presented to the ED for the second time. Magnetic resonance imaging was performed and revealed a high intensity mass. INTERVENTION AND OUTCOME: The soft tissue mass identified on magnetic resonance imaging was surgically removed. Shortly after the surgery, the patient developed post-operative bleeding and was returned to surgery. During the second procedure, he developed a post-operative hemorrhage related to the development of disseminated intravascular coagulation and subsequently died during the second procedure. A malignant lumbosacral chordoma was diagnosed on pathologic examination. CONCLUSION: This case report describes the presentation of a patient with lumbosacral chordoma presenting with musculoskeletal low back pain. Chordomas are rare with few prominent manifestations. An early diagnosis can potentially make a difference in morbidity and mortality. Due to its insidious nature, it is a difficult diagnosis and one that is often delayed.
Entities:
Keywords:
Chiropractic; Chordoma; Low back pain; Lumbosacral region
Authors: Brian J Williams; Daniel M S Raper; Erin Godbout; T David Bourne; Daniel M Prevedello; Amin B Kassam; Deric M Park Journal: J Natl Compr Canc Netw Date: 2013-06-01 Impact factor: 11.908
Authors: Anna V Nikoghosyan; Irini Karapanagiotou-Schenkel; Marc W Münter; Alexandra D Jensen; Stephanie E Combs; Jürgen Debus Journal: BMC Cancer Date: 2010-11-05 Impact factor: 4.430