Sciatica is most commonly attributed to degenerative disc diseases. However, symptoms may occur secondary to a spinal tumor or they may be found accidentally on imaging. The subject of this case study is a 67 year old female who presented to a community physiotherapy clinic with left sided sciatica. The subject reported previous history of sciatica on the same side. Neurological examination revealed decreased strength and light touch sensation in the left L4 nerve root distribution. Straight leg raise test was positive and reproduced radicular pain on the affected side. Lumbar spine x-rays and reports were inconclusive. Physiotherapy treatment was directed towards treatment for prolapsed disc and included modalities for pain, acupuncture and exercises. Unfortunately this patient did not respond to conservative treatment and was therefore referred back to her physician requesting Magnetic Resonance imaging (MRI). MRI results demonstrated an L4-L5 left extraforaminal disc protrusion and tiny intradural, extramedullary lesion adjacent to the right L4 nerve root, which could be indicative of a nerve sheath tumors. Though the coexistence of degenerative disc disease and spinal tumors is not common, there have been previous reports and reference to this in literature. Although nerve root compression due to spinal tumors or degenerative disc disease cannot be easily distinguished, the presence of a spinal tumor should be considered a differential diagnosis when examining patients presenting with sciatica. Therefore, when conducting an examination and taking the subjective history, physiotherapists must be familiar with the red flags associated with the more serious underlying causes of back pain. It is the responsibility of the treating clinician to refer the patient for further evaluation and imaging when the patient is not making any progress with conservative treatment.

Sciatica, Spinal Tumor, Degenerative Disc Disease, Disc Prolapse