METASTATIC CANCER OF THE LUNG AND LUMBAR SPINE MIMICKING LOW BACK PAIN: A CASE REPORT

¹ Faculty of Medicine, Rehabilitation Sciences, The Catholic University "Our Lady of Good Counsel" Tirana, Albania

Correspondence to:

Journal of Orthopedics 2024 May-August; 16(2): 81-86

Received: 5 May 2024 Accepted: 12 June 2024

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Abstract

The purpose of this case study is to describe the presentation of a patient with persistent back pain and leg pain with no prior diagnosis of cancer and to describe the clinical course of a patient referred to physiotherapy (PT) for treatment, which was subsequently diagnosed with metastatic cell carcinoma of the lung and bone. A 76-year-old woman was referred to PT for the evaluation and treatment of an insidious onset of low back and leg pain of 3-month duration. She had positive neurologic signs or symptoms suggestive of radiculopathy, recent weight changes, and general health concerns. She received mild relief during the first office visit, including manipulation, tecar therapy, moist heat, and electro-acupuncture stimulation. Although the patient experienced some pain relief after her physiotherapy treatment, she continued to have persistent mild pain in the lumbar area. The patient’s history and physical examination were consistent with a mechanical neuromusculoskeletal dysfunction, and no red flag findings warranted immediate medical referral. Short-term symptomatic improvements were achieved using PT treatment. However, despite 5 PT sessions over 5 weeks, the patient did not experience long-term symptomatic improvement. On the fifth session, the patient reported a 7-day history of right hand and leg weakness and breathing problems. This prompted the physiotherapist to refer the patient to the emergency department. Abnormal examinations and radiographic findings were discovered. 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 the pulmonologist and oncologist. This case highlights the importance of patient health history and further investigation of the red flags of persistent pain in patients. Differential diagnosis is a key component of PT practice. Low back pain recurrence in an established patient should constitute a reevaluation of the problem. The cause cannot be assumed to be musculoskeletal in origin, even though this may have been the case with the initial complaint. Metastatic disease should be considered with any type of recurrent low back pain. The ability to reproduce symptoms or achieve short-term symptomatic gains is not sufficient to rule out threatening pathology.

Keywords: diagnostic imaging, differential diagnosis, low back pain, lung cancer, metastatic carcinoma