Skip to main content
AAPM&R Events Main banner
JFK Johnson
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
In-Person
In-Person
On Demand
On Demand
Live Stream
Live Stream
Invite Only
Invite Only
Ticketed
Ticketed
Coffee Break
Coffee Break
Meal
Meal
Reception
Reception
Back

Pain and Spine Medicine

A Rare Presentation of Lumbar Ependymoma: A Case Report

Thursday, November 16, 2023

    Primary Author(s)

  • Elizabeth A. Callahan, DO

    Resident
    New York University Grossman School of Medicine PM&R Program
    New York, New York

    • Co-Author(s)

  • Julia Tsinberg, MD

    PGY-4
    New York University Grossman School of Medicine PM&R Program
    New York, New York

  • Zuhair Khan, DO

    PGY-3
    New York University Grossman School of Medicine PM&R Program
    New York, New York

Case Diagnosis: Lumbar Ependymoma

Case Description or Program Description: 45-year-old male presents for evaluation of acute on chronic low back pain. The pain acutely worsened 9 days prior to presenting to clinic. Pain radiates to bilateral buttocks and hamstrings. Denies any red flag symptoms.

Setting: Outpatient clinic

Assessment/Results: His neurological exam was intact, with full strength. However, the patient had exquisite low back pain with active knee extension. Given the amount of pain on initial exam, the patient was unable to tolerate physical therapy (PT) and a lumbar MRI was ordered for further evaluation. He was prescribed oral NSAIDs PRN, and muscle relaxants PRN. Lumbar MRI revealed intradural lesion at the L4-L5 level. The patient was referred to neurosurgery for further management. He underwent laminectomy for resection of tumor. Pathology results consistent with myxopapillary ependyomoma, WHO grade II.

Discussion (relevance): This is a rare presentation of lumbar ependymoma in the setting of low back pain with a normal neurologic exam. Ependymomas are relatively rare tumors, compromising 55-75% of lesions in the spinal cord, most commonly occurring in the cervical or thoracic region, and rarely in the lumbar. Although benign, intradural ependymomas can grow and disseminate through the central nervous system. The treatment of choice for these tumors is surgical resection. This patient had timely imaging and evaluation by neurosurgery leading to his successful treatment. Had lumbar MRI been delayed to assess the patient’s tolerance of PT, this tumor could have grown and led to spinal cord compression.

Conclusions: The case highlights the importance of obtaining lumbar MRI imaging in patients presenting with acute onset low back pain. MRI imaging should not be delayed to assess tolerance or progression in PT, as this can increase the burden of disease. It is important for physicians evaluating musculoskeletal pain to be aware of ependymoma as an etiology of low back pain.