Introduction:Due to increased number of available alternative therapies to the treatment of back pain and sometimes a difficult access to specialized medical evaluations, there is a widespread use of alternative therapies for the treatment of back pain. Case Description: We describe a case with a catastrophic consequence of massage therapy in a patient with initial symptoms of back pain resulting in definitive paraplegia and discuss the needs for medical diagnosis for any treatment. Discussion and Conclusion: We discuss the potencial harms to the patient when initiating a questionable treatment method, which are late diagnosis, direct physical harm, interference with tradiotional treatments, financial harm and time loss. Alternative treatments are valuable tools to control refractory symptoms, especially pain. But we reinforce the need of adequate medical screening before performing therapies which may bring unwilling outcomes. RESUMO Introdução: Devido à disponibilidade crescente de terapias alternativas para o tratamento de dor nas costas e acesso por vezes difícil de avaliações médicas especializadas, há um amplo uso de terapias alternativas para o tratamento de dor nas costas. Descrição do Caso: Descrevemos um caso com uma consequência catastrófica de massagem terapêutica em um paciente com sintomas iniciais de dor nas costas, resultando em paraplegia definitiva e discutimos as necessidades de diagnóstico médico para qualquer tratamento. Discussão e Conclusão: Discutir os danos potenciais ao paciente, ao iniciar um método de tratamento questionável, que são o diagnóstico retardado, dano físico direto, interferência com tratamentos tradicionais, prejuízos financeiros e perda de tempo. Os tratamentos alternativos são ferramentas valiosas para controlar os sintomas refratários, especialmente a dor. Mas reforçamos a necessidade do rastreio médico adequado antes de realizar terapias que podem trazer resultados controversos. Palavras-chave:Dor nas costas; Tratamento alternativo; Paraparesia 313 Case Report J Bras Neurocirurg 24 (4): 313 -315, 2013 Botelho RV, Oliveira MF, Reis RC, Ferreira JA, Filho STG, Rotta JM. -Paraplegia following massage therapy intervention in a patient with undiagnosed multiple myeloma 314 Case Report Botelho RV, Oliveira MF, Reis RC, Ferreira JA, Filho STG, Rotta JM. -Paraplegia following massage therapy intervention in a patient with undiagnosed multiple myeloma J Bras Neurocirurg 24 (4): 313 -315, 2013 Conflicts of interest: The authors declare no conflicts of interest. 315 Case Report J Bras Neurocirurg 24 (4): 313 -315, 2013

H?rthle cell carcinoma is a rare variant of differentiated thyroid cancer and occasionally generates distant metastases. There are few reports of H?rthle cell carcinoma metastases to the vertebral column and none with sacral involvement. Here, we report a 48-year-old woman with a 2-year history of moderate low back pain, alleviated with analgesic medication. Her previous medical files were unremarkable. She performed medical evaluation, and a magnetic resonance of lumbar spine revealed a solitary hypointense T2 lesion on the left lamina of S1. The patient was submitted to percutaneous biopsy that displayed carcinomatous pattern compatible with H?rthle cell carcinoma of thyroid. After that, she was submitted to thyroid ultrasound that showed a nodule. Even in the presence of metastases, patients with H?rthle cell carcinoma usually have a relatively good prognosis. We discuss aspects of the diagnosis, management, and surgical treatment of metastatic H?rthle cell carcinoma in reference to the literature.