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Cervical Schwannoma camouflaged by cervical intervertebral disc prolapse—A case report

Spinal Cord Series and Cases volume 9, Article number: 52 (2023) Cite this article

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Abstract

Introduction

Cervical prolapsed intervertebral disc is one of the common conditions causing cervical myeloradiculopathy. Anterior Cervical Discectomy and Fusion (ACDF) is the standard line of management for the same. Intradural neurogenic origin tumors are relatively rare and can present with features of myeloradiculopathy. Radiological imaging plays important role in diagnosis of such pathologies.

Case report

We report a patient with C5-6 cervical disc prolapse that presented with radiculopathy symptoms in the right upper limb, which was refractory to conservative care. He underwent a C5-6 ACDF and reported complete relief from symptoms at 4 weeks. He developed deteriorating symptoms over the next 10 weeks and presented at 14 weeks follow-up with severe myeloradiculopathy symptoms on the left upper limb with upper limb weakness. A fresh MRI identified an intradural extramedullary tumor with cystic changes at the index surgery level. This was treated with tumor excision and histopathology confirmed a diagnosis of schwannoma. Simultaneous presence of cord signal changes with disc herniation obscured the cystic schwannoma which became apparent later on contrast enhanced MRI imaging.

Conclusion

Careful review of preoperative imaging and contrast MRI study may help in diagnosing cystic schwannomas with concomitant cervical disc herniations that have cord signal changes.

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Fig. 1: Preoperative radiological evaluation.
Fig. 2: Post operative cervical spine X-rays.
Fig. 3: 14 weeks postoperative MRI scan.
Fig. 4: Pathology specimen.

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Authors and Affiliations

  1. Department of Spine Surgery, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, 411005, India

    Shailesh R. Hadgaonkar, Nishad V. Situt, Shivan Marya & Siddharth N. Aiyer

  2. The Dean, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, 411005, India

    Parag K. Sancheti

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  1. Shailesh R. Hadgaonkar
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  2. Nishad V. Situt
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  3. Shivan Marya
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  4. Siddharth N. Aiyer
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Contributions

SRH: conceptualization, methodology, supervision, project administration; NVS and SM: data curation, writing draft, visualization; SNA: modification of primary draft, investigation, review and editing, project administration; PKS: project management. All authors read and approved the final manuscript.

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Correspondence to Nishad V. Situt.

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Hadgaonkar, S.R., Situt, N.V., Marya, S. et al. Cervical Schwannoma camouflaged by cervical intervertebral disc prolapse—A case report. Spinal Cord Ser Cases 9, 52 (2023). https://doi.org/10.1038/s41394-023-00609-y

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