1334 - Unmasking the Hidden Culprit: Incidental Schwannomas as an Underdiagnosed Etiology of Chronic Back Pain

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

TS

Toufiq Swaid, MD

PGY-3 Resident Physician
Tufts Medical Center
Cambridge, Massachusetts, United States

Co-Author(s)

CM

Carlo Magaway, DO

Resident
LECOM
Erie, Pennsylvania, United States

Corresponding Author(s)

DR

David Rustom, MD

MD
Wayne State Univ/Detroit Med Center
Detroit, Michigan, United States

Submitter(s)

TS

Toufiq Swaid, MD

Rutgers, New Jersey Medical School
Warren, Michigan, United States

Case Diagnosis: A 54 year old female who was incidentally discovered to have an intradural, extra medullary schwannoma.

Case Description: Patient presented to the pain clinic after experiencing chronic back pain for the past 6 months, accompanied by new-onset right-sided chest, abdominal, and rib pain radiating in a radicular fashion, suggestive of a thoracic radiculopathy. She failed medication management with NSAIDs and opiates, as well as physical therapy. Pain significantly interfered with her activities of daily living. MRI pan scan of her back revealed an incidental heterogeneous intradural, extramedullary mass on the right side of the spinal canal at the T3 level, with severe compression of the spinal cord but no intramedullary involvement. Notably, the patient did not exhibit subjective or objective clinical signs of myelopathy.

Discussions: This case highlights the diagnostic challenge of spinal schwannomas, which often present with nonspecific back pain or radiculopathy. Chronic back pain, a leading cause of disability worldwide, is typically attributed to degenerative or musculoskeletal etiologies, and neoplastic causes are frequently overlooked. Incidental schwannomas may therefore be underdiagnosed. In a meta-analysis of 2,542 spinal schwannomas, back pain was reported in up to 72% of patients. Similarly, among 82 retroperitoneal schwannomas, 6.1% presented with low back pain and 34.1% were diagnosed incidentally. Our patient had severe cord compression without myelopathy, consistent with reports that symptomatic myelopathy occurs in only 30–40% of intradural, extramedullary schwannomas, underscoring heterogeneous presentations.

Conclusions: Although rare, schwannomas should be considered in the differential for patients with persistent, but unexplained back pain - especially when standard treatments fail. Improved awareness and consideration of neoplastic etiologies in refractory pain cases, particularly when conventional imaging or therapy fails, can facilitate timely diagnosis and better outcomes.