SHM Converge Scientific Abstract ePoster Gallery-Not All Back Pain Is Created Equal

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This case highlights that not all back pain is benign. A 69-year-old woman presented with acute worsening of subacute low back pain after a fall 12 weeks earlier. Despite conservative outpatient treatment and physical therapy, her pain became severe enough to wake her at night, and she developed new urinary incontinence. She also reported fatigue, poor appetite, and a 10-pound unintentional weight loss over one month. Her history was notable for breast cancer in remission, making malignancy a major concern.<br /><br />The discussion emphasizes that low back pain is common and usually does not need imaging, but clinicians must recognize red flag symptoms. These include constitutional symptoms, trauma, cancer history, infection risk, immunosuppression, failure of conservative therapy, and neurologic deficits such as urinary retention or incontinence, saddle anesthesia, or progressive weakness. When red flags are present, urgent MRI is the preferred imaging test.<br /><br />In this patient, advanced imaging revealed compression fractures, spinal canal stenosis with cord compression at T11 and T12, and multiple enhancing lesions throughout the cervical, thoracic, and lumbar spine. CT of the chest, abdomen, and pelvis showed retroperitoneal lymphadenopathy and widespread mixed lytic and sclerotic bone lesions. Biopsy of a retroperitoneal lymph node confirmed metastatic breast adenocarcinoma. SPEP and UPEP were negative.<br /><br />Her pain remained difficult to control with opioids, antispasmodics, and steroids, prompting involvement of spine surgery and radiation oncology. She ultimately received spinal radiation therapy.<br /><br />The main lesson is that acute back pain with red flag features requires expedited workup to avoid delayed diagnosis of serious conditions such as malignancy, cauda equina syndrome, spinal epidural abscess, osteomyelitis, or compression fracture. Early multidisciplinary care is essential when spinal malignancy is suspected.

Asset Subtitle

Sanjna Rajput

Meta Tag

Author List Meltiady Issa, Sanjna Rajput

Category Clinical Vignettes

Concept Low Back Pain

Concept Red Flag Symptom

Concept Magnetic Resonance Imaging

Concept Malignancy History

Concept Neurologic Deficit

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Sanjna Rajput

Track Adult

Keywords

low back pain

red flag symptoms

spinal cord compression

metastatic breast cancer

urinary incontinence

MRI imaging

compression fractures

bone metastases

cauda equina syndrome

radiation therapy

Low Back Pain

Red Flag Symptom

Magnetic Resonance Imaging

Malignancy History

Neurologic Deficit