Clinical Case Database / Category: Patient Management
Back pain having spinal cord compression
Publication details
Dr Sarah Twigg, Dr Lesley Hordon
Foundation Years Journal, volume 9, issue 10, p.21 (123Doc Education, London, November 2015)
Abstract
A 54 year old man presented with worsening lower lumbar pain radiating down his thighs and a band-like pain across the upper abdomen. He was known to have monoclonal gammopathy of uncertain significance (MGUS). Initial neurological examination revealed an absent left ankle jerk reflex and reduced sensation over the lateral left calf with a normal digital rectal examination; however on repeated assessment, a right sided foot drop and absence of the right ankle jerk reflex had developed, together with loss of peri-anal sensation. Spinal cord compression was suspected and urgent magnetic resonance imaging (MRI) revealed a diffuse infiltrative process affecting the vertebral bodies, with lesions compressing the spinal cord from T5 to T7 and L4 to S1. Subsequent examination of the bone marrow confirmed the diagnosis of myeloma. It is important to exclude metastases in a patient presenting with back pain when there is a history of malignancy or pre-malignant condition. Furthermore, repeated neurological examination can be essential to detect signs of spinal cord compression.
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Authors
Dr Sarah Twigg (Corresponding author)
Clinical lecturer in rheumatology
University of Leeds and Leeds Teaching Hospitals NHS trust
Leeds Institute Rheumatic and Musculoskeletal Medicine
Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA
s.twigg@Leeds.ac.uk
Dr Lesley Hordon
Consultant Rheumatologist
Dewsbury hospital
Halifax Road, Dewsbury, WF13 4HS
lesley.hordon@midyorks.nhs.uk
References
1. Rajkumar SV, Kyle RA, Connor RF. Clinical features, laboratory manifestations, and diagnosis of multiple myeloma. UpToDate Wlatham, MA. (Accessed on July 17th 2015). 2015.
2. Underwood M. Diagnosing acute nonspecific low back pain: time to lower the red flags? Arthritis Rheum. 2009 Oct;60(10):2855-7. PubMed PMID: 19790072.
3. Patten J. Neurological differential diagnosis : an illustrated approach with 288 figures. Rev. reprint. ed. London: Starke, 1978; 1977.
4. Kastritis E, Zagouri F, Symeonidis A, et al. Preserved levels of uninvolved immunoglobulins are independently associated with favorable outcome in patients with symptomatic multiple myeloma. Leukemia. 2014 10//print;28(10):2075-9.
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About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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