Conus medullaris tumor co-existed with chronic low back pain: a case report and literature review.

Background: Low back pain (LBP) is one of the most prevalent global health issues, often attributed to degenerative lumbar conditions. However, it can occasionally obscure more serious pathologies such as spinal tumors. Conus medullaris syndrome (CMS), a rare and frequently underrecognized cause of chronic LBP, illustrates the consequences of delayed diagnosis and underscores the need for systemic improvements in early detection. Case Description: We present a 48-year-old female with a long-standing history of presumed mechanical LBP, whose progressive neurological decline was initially misattributed to autoimmune comorbidities. Thoracic magnetic resonance imaging (MRI) ultimately revealed an intradural extramedullary tumor at T11-T12, confirmed intraoperatively as a schwannoma. Surgical resection led to restored ambulation within 3 months, with sustained neurological recovery and no recurrence at three years, apart from mild residual urinary symptoms. Conclusions: This case highlights the diagnostic complexity of CMS and the importance of early thoracic imaging in patients with atypical or progressive symptoms. Broader implementation of subsidized imaging, standardized referral systems, and provider education can reduce diagnostic delays and improve outcomes, especially in resource-constrained environments. International collaboration is essential to enhance equity in the diagnosis and management of rare spinal tumors.