Diagnostic Pitfalls• Cancer and metastasis of the spine can mimic

degenerative back and neck pain

• Early referral and early and wider use of MRI scans is essential to avoid missing serious pathology

• High Index of suspicion vital. Always ask history of previous malignancy

• 20% have no history of a primary malignancy

PC. F=62.

• C/o LBPx 6 months• Progressively worse• Radiates to left hip and thigh area• No red flags• Pain increased on sitting an walking• Still at work

PC. F=62

• O/E: Tender Left L3-5 area• SLR on left +ve at 60 degrees• Left SI joint tender• Reduced sensation left leg

PC. Xrays.

Narrowing L45 Disc space

Early OA in Left Hip

Rx- Physio, Pain killers, Exercise programs

Not settling

PC. MRI ScansMetastasis at T5, T8 and

L1, with bulging at T5.

? Left Hip pain referred from L1 area

No known Primary

Treated by radiotherapy.