Lung Cancer With Vertebral Metastases Presenting as Low Back Pain in the Chiropractic Office: A Case Report

Chu, Eric Chun-Pu; Trager, Robert J.; Lee, Wai Ting; Cheong, Benjamin Kah Chun; Hei, Steve Yun Ming

doi:10.7759/cureus.34821

Cited by 10 publications

(11 citation statements)

References 14 publications

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“…A patient’s medical history and physical examination may reveal symptoms and signs suggestive of a sacral chordoma. While musculoskeletal conditions are commonly encountered by chiropractors [ 6 ], the present case highlights the importance of being vigilant for rare diseases, such as sacral chordomas, which may present with nonspecific clinical features mimicking more common musculoskeletal disorders [ 5 , 7 - 17 ]. Both patients presented with symptoms suggestive of a sacral chordoma and the MRI findings were consistent with the typical features of a sacral chordoma.…”

Section: Discussionmentioning

confidence: 99%

Sacral Chordoma Presenting as Back Pain in the Chiropractic Clinic: A Case Report

Chan¹,

Ng²,

Cheong³

et al. 2023

Cureus

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Cases of lumbar and gluteal pain are commonly encountered in chiropractic clinics, with a broad differential diagnosis primarily centered on musculoskeletal conditions. This report presents the second documented case of sacral chordoma diagnosed at a chiropractic clinic and emphasizes the importance of considering alternative diagnoses and interdisciplinary collaboration in patient care. A 42-year-old man presented to a chiropractic clinic with complaints of lumbar and gluteal pain. The initial conservative management based on a presumptive musculoskeletal diagnosis was ineffective. Suspicion of an alternative etiology prompted a referral for imaging, which revealed a sacral chordoma. An interdisciplinary collaboration involving orthopedic surgeons, oncologists, radiologists, and other healthcare professionals was initiated to optimize the treatment outcomes of this rare and aggressive tumor. This case report underscores the importance of maintaining a high index of suspicion in cases of musculoskeletal presentations in chiropractic clinics and the critical role of advanced imaging in establishing a definitive diagnosis. Interdisciplinary collaboration is essential for managing complex conditions such as sacral chordomas, ensuring the delivery of the highest quality of care, and optimizing patient outcomes. Chiropractors play a crucial role in identifying, referring, and contributing to the management of patients with complex presentations as part of a comprehensive multidisciplinary treatment plan.

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Section: Discussionmentioning

confidence: 99%

Sacral Chordoma Presenting as Back Pain in the Chiropractic Clinic: A Case Report

Chan¹,

Ng²,

Cheong³

et al. 2023

Cureus

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“…Advanced imaging is essential for the early detection of abnormalities and diseases, allowing prompt intervention and treatment [8]. When substantial pain relief is not achieved with standard analgesics and conservative therapies, Hong Kong chiropractors often perform advanced imaging [9][10][11][12][13][14] to identify the defining features of spinal metastasis. The patient's MRI confirmed an infiltrative bone marrow process and pathologic fracture.…”

Section: Discussionmentioning

confidence: 99%

Thyroid Cancer Presenting as Neck Pain at a Chiropractic Clinic

Cheong,

Teh,

et al. 2023

Cureus

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We report an unusual case of metastatic papillary thyroid carcinoma presenting with progressive neck pain in a 58-year-old female with known bilateral thyroid nodules. Despite initial benign ultrasonographic findings and trials of conservative therapy for over 2 months, the patient’s anterior neck pain and unremitting symptoms prompted concern regarding an underlying orthopedic condition. She sought chiropractic consultation, and MRI revealed pathologic vertebral fractures. Biopsy of the thyroid and vertebral bone lesions demonstrated metastatic thyroid carcinoma. The patient was diagnosed with papillary thyroid cancer. The early detection of metastatic disease is critical for optimizing oncological treatment and outcomes. This case highlights the importance of close follow-up when the initial workup or management fails, consideration of sinister pathologies in high-risk patients, and a multidisciplinary approach to complex conditions. It provides an important reminder not to attribute unresolved symptoms to benign causes without serial re-evaluation, especially in patients with known risks, such as thyroid disease. A high index of suspicion and openness to atypical disease presentations is fundamental to avoid missed opportunities for diagnosis and prompt treatment.

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“…The complaint is usually at the level of the lesion. However, nerve involvement through compression could lead to a potential dermatomal distribution ( 37 ). Differentiating between causes through the correct imaging diagnostic, such as an MRI, is critical for treating the conditions since the patient could present with a more mainstream symptom of the spine, even when the primary tumor is yet to be found ( 38 ).…”

Section: Non-mechanical or Systemic Conditionsmentioning

confidence: 99%

“…Nevertheless, special attention should be placed on cases with known cancer that present with newly acquired back pain. A metastatic lesion is a common reason for a pathological fracture since the tumor cells are a source of osteoclastic and osteolytic activity, in which case the patient could present with excruciating axial and radicular pain ( 6 , 37 , 38 ).…”

Section: Non-mechanical or Systemic Conditionsmentioning

confidence: 99%

Common differential diagnosis of low back pain in contemporary medical practice: a narrative review

Ferdinandov,

Yankov,

Trandzhiev

2024

Front. Med.

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With a wide range of etiologies, low back pain (LBP) presents a true clinical challenge, finding its origins both in intrinsic spinal and systemic conditions, as well as referred ones. This review categorizes the LBP into these three groups and aims to offer a comprehensive look at the tools required to diagnose and differentiate them. The intrinsic etiologies are based on conditions that affect the musculoskeletal components of the lumbar spine, such as intervertebral disc disease, stenosis, muscular imbalance, and facet joint degeneration. The systemic causes usually extend beyond local structures. Such are the cases of neoplasia, infections, and chronic inflammation. The diagnosis is rendered even more complex by adding the referred pain, which only manifests in the lower back yet arises in more distant locations. By synthesizing the literature that encompasses the problem, this review aims to augment the understanding of the differential diagnoses of LBP by showcasing the subject’s nuances. This categorization provides a structured approach to a patient-centered diagnosis, which could facilitate the medical practitioners’ efforts to navigate this pathology more effectively.

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Lung Cancer With Vertebral Metastases Presenting as Low Back Pain in the Chiropractic Office: A Case Report

Cited by 10 publications

References 14 publications

Sacral Chordoma Presenting as Back Pain in the Chiropractic Clinic: A Case Report

Sacral Chordoma Presenting as Back Pain in the Chiropractic Clinic: A Case Report

Thyroid Cancer Presenting as Neck Pain at a Chiropractic Clinic

Common differential diagnosis of low back pain in contemporary medical practice: a narrative review

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