An Early Symptom of Cauda Equina Tumor in Joggers

One of the major considerations of all doctors during a case history for back pain is the possibility of tumor or spinal metastasis. The alarm rings when the patient, especially over 50, relates a history of a previous malignancy, a chronic unexplained cough, unexplained weight loss and nocturnal recumbent pain that is often relieved by nocturnal chair sitting. But even before some of these suspicious findings a tumor can be present and the patient may be treated for a mechanical back problem. Radiographs are often negative and spinal adjustments may temporarily improve the condition. Of course if a tumor is causing symptoms, usually within four weeks the condition will no longer improve and the above signs and symptoms will increase in severity. Neurological symptoms and signs are seen in only 5-10 percent of cancer patients who develop spinal metastases.¹

Inoue et al.,² found some interesting symptoms that were related to cauda equina tumor in the very earliest stage of the condition before the onset of recumbent night pain. In athletic patients they noticed a complaint of alternating bilateral sciatica that was synchronized with each stride during jogging. A careful history is necessary because the alternating sciatica did not create a severe pain. Except for jogging the patients were free of pain in daily activities. They found this symptom in six of eight patients with eventual cauda equina or lumbosacral cord tumor. Only one of 33 athletes with just lumbar disc herniations ever remembered this type of symptom.

The authors² explained that the alternating sciatica was caused by a mobile tumor in the intradural space that accompanied up and down acceleration and deceleration during jogging. Jogging created radicular pain by causing alternating pressure on the nerve roots. One patient experienced right leg pain when his body tilted to the right and left leg pain when his body tilted to the left. They felt that the relief of night pain by sitting was a symptom in the late stage of the disease, at which time the tumor had become immobile. The alternating bilateral sciatica on jogging was seen only in athletic patients.

References

1. Constans JP, DeDivitiis E, Donzelli R, et al. Spinal metastases with neurological manifestations. J Neurosurg 59;1983:111-118.

    

2. Inoue K, Hukuda S, Katsuura A, Saruhashi Y. Alternating sciatica while jogging, an early symptom of cauda equina tumor. Clin Orth & Rel Res 328, 1996:102-107.