Diagnostic Pitfalls
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Diagnostic Pitfalls• Cancer and metastasis of the spine can mimic
degenerative back and neck pain
• Early referral and early and wider use of MRI scans is essential to avoid missing serious pathology
• High Index of suspicion vital. Always ask history of previous malignancy
• 20% have no history of a primary malignancy
PC. F=62.
• C/o LBPx 6 months• Progressively worse• Radiates to left hip and thigh area• No red flags• Pain increased on sitting an walking• Still at work
PC. F=62
• O/E: Tender Left L3-5 area• SLR on left +ve at 60 degrees• Left SI joint tender• Reduced sensation left leg
PC. Xrays.
Narrowing L45 Disc space
Early OA in Left Hip
Rx- Physio, Pain killers, Exercise programs
Not settling
PC. MRI ScansMetastasis at T5, T8 and
L1, with bulging at T5.
? Left Hip pain referred from L1 area
No known Primary
Treated by radiotherapy.