An Unusual Case of Low Back Pain

A 35 year old male patient with a low back injury since 2003, who at the time suffered pelvic bone fracture, inferior cava vein lesion with local thrombosis and transitory paraplegy. He complained of severe low back pain in the vertebral bones, right paraspinal muscles, right groin, right sciatica, besides, epigastric pain.

CT scans, MRI's images, and ultrasound studies showed the inferior cava vein colapsed by a big hematic collection

There was no strong evidence of “red flags” for back pain.

In 2004, the patient suffered a deep vein trombosis and was prescribed anticoagulant drugs for a year.

He took tramadol (up to 300 mg/day), clonazepam (up to 6 mg/day), oxycodone (low dose: difficult to tolerate, ineffective), methadone (low dose: difficult to tolerate, ineffective), NSAID's (Diclofenac, Meloxicam: ineffective), Pregabalin (150 mg/day: difficult to tolerate, ineffective), acupuncture (ineffective), fentanyl transdermal patches (25 mcg/hour: difficult to tolerate, ineffective), duloxetine (30 mg: difficult to tolerate, ineffective), ), TENS (ineffective), facet joint and radicular anesthesic blockade (ineffective).

The pain (deep and drilling with brief electrical shocks) was described as severe (scale intensity: 8/10).

Before using an infusion pump or a neurostimulator method we recommended the patient to see a vascular surgeon in order to withdraw the thrombotic mass through surgery in an attempt to ease the pain.

The patient underwent surgery in October 2007.

We were surprised by the following surgical findings: there were no thrombus, the inferior cava vein was not compromised, and there was an expansive tumoral mass compressing the structures nearby.

The tumoral mass was analyzed at a pathology laboratory and the results suggest either a Schwannoma or neurilemoma. It is still under evaluation

We hope that these findings provide the necessary information in order to reach the most adequate treatment for this patient.