EC Clinical and Medical Case Reports

Schwannomas are typically solitary, slow-growing benign nerve sheath tumours, most often incidental findings on cross-sectional imaging. The presence of multiple, multilevel lesions is uncommon and carries distinct imaging and clinical implications compared with the solitary sporadic form. We report the case of a 64-year-old man with no significant past medical history, presenting with a several-month history of bilateral low back pain, more pronounced on the left side. Spinal MRI identified multiple small left-sided paraspinal masses at staged (multilevel) lumbar levels, arising from adjacent nerve roots and causing dilatation of the conus medul- laris, with morphological and enhancement characteristics most suggestive of schwannomas. The left-sided predominance of these lesions was anatomically concordant with the laterality of the patient’s pain. Further management was under multidisciplinary dis- cussion at the time of writing. This case illustrates the imaging characteristics of multilevel paraspinal schwannomas and highlights the importance of consider- ing this rare entity, together with an underlying tumour predisposition syndrome, in the differential diagnosis of atypical or refrac- tory low back pain.

Keywords: Schwannoma; Paraspinal Mass; Multilevel; Low Back Pain; MRI

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