Metastatic Cancer of the Thoracic and Lumbar Spine Presenting as Mid- and Low Back Pain in a Long Distance Runner.

OBJECTIVE: The purpose of this case study is to describe the presentation of a patient with persistent back pain and a history of carcinoma.

CLINICAL FEATURES: A 50-year-old female runner presented to a chiropractic office with persistent moderate low back and mid-back pain. She had a history of breast carcinoma. She had no positive neurologic signs or symptoms suggestive of radiculopathy. She denied any other health symptoms and received mild relief with only 1 office visit consisting of spinal manipulation, moist heat, and electrical stimulation. Although the patient experienced some pain relief after her chiropractic treatment, she continued to experience persistent mild pain in the thoracolumbar area.

INTERVENTION AND OUTCOME: Because of the patient's lingering back pain, she was referred for lumbar spine radiographs. On evaluation of the radiographs, a missing right L3 pedicle was seen. A subsequent computed tomography scan of the lumbar spine revealed marked metastatic changes to the lower thoracic and upper lumbar spine. The patient was immediately referred to her oncologist. The metastatic changes had progressed to her liver, and she succumbed to the disease 6 months later.

CONCLUSION: This case highlights the importance of patient health history and further investigation of the red flag of persistent pain in patients with a history of carcinoma.