Cauda Equina Syndrome in a Patient with Intradural Schwannoma at the Same Level as an Acute L2 Compression Fracture

Intradural tumors are found often as either incidental findings or during evaluation during magnetic resonance imaging (MRI) for lumbar and/or radicular pain. This patient presented with an acute L2 compression fracture, however, the initial MRI identified a large spinal mass separate from the fracture but at the same level. The patient had acute upper lumbar pain after a fall but the neurologic examination also revealed findings of early cauda equina syndrome with muscle weakness, asymmetric leg numbness, and urinary incontinence. Further history revealed the patient had been using a cane for several months and having difficulty walking with some upper lumbar pain but had not seen a physician. The differential was an extruded disc associated with the fractured endplate versus a tumor. Because of the neurologic symptoms, emergency open decompression combined with multilevel screw fixation was performed. At the time of the laminectomy, the dura bulged posteriorly, no ventral disc was found, and a 3-cm intradural schwannoma was successfully excised with rapid neurologic recovery. The article will review the relationship of cauda equina syndrome with osteoporotic fractures and the rarity of actual true disc extrusion with compression fractures, as well as the more common relationship of finding cauda equina syndrome with intradural tumors when there is severe canal stenosis as seen in this unusual case.