Abstract / Summary
Presentation and Initial Workup A 36-year-old female presented on November 18, 2025, with lumbar pain and left lower extremity radiculopathy. Following a comprehensive history, physical examination, and radiographic evaluation to assess anatomical and biomechanical factors, an urgent lumbar MRI was ordered due to the patient’s radiculopathic symptoms and clinical findings. The MRI was ordered promptly. At the subsequent visit, the patient provided the MRI disc; however, a formal radiology report had not yet been received. Chiropractic Review and Medical Collaboration Upon reviewing the MRI later that day, the treating chiropractor, Dr. Tim Clare identified abnormal findings within the central canal spanning the approximate region of L2 to L4. Recognizing the clinical significance of this finding, Dr. Clare contacted Dr. Mark Studin, one of his graduate instructors, for immediate consultation. Dr. Studin, in turn, collaborated with a medical neuroradiologist affiliated with a New York medical school for confirmation. Based on the available MRI sequences (including T1 and T2 axial and sagittal views), the consulting clinicians concluded there was a probable intradural mass lesion, with a differential diagnosis that included ependymoma, extending from approximately the L2 level into the inferior spinal canal region of L4. Given the potentially serious implications, Dr. Clare made the clinical decision to initiate urgent referral for further imaging (including contrast studies) and specialist evaluation. Referral Coordination To ensure timely management, Dr. Clare reviewed regional referral resources and initiated an urgent referral to Duke University Neurosurgery, widely recognized for advanced spine and neurosurgical care. He personally contacted the facility to communicate the urgency and expedite the consultation process. The following morning, Dr. Clare met with the patient and reviewed the MRI findings. He explained that, beyond degenerative changes and disc pathology, there were additional concerning findings requiring immediate clarification and specialty assessment. He emphasized that the suspected lesion could represent a serious diagnosis and warranted urgent follow-up. The patient was advised that further treatment decisions in the chiropractic office would be deferred until an accurate diagnosis was established. She expressed understanding and was encouraged to stay in contact with Dr. Clare.