Q- A 54-year-old man visits his physician for evaluation of low back pain. He has a history of lung cancer and he receives a combination of radiation and chemotherapy. His back pain started 3 months ago and now he complains of numbness and tingling in his lower limbs.
What is the most likely cause of this patient’s back pain?
A- Paraneoplastic disease
B- Metastases to the vertebral column
C- Muscular spasm of paravertebral muscles
D- Primary osteosarcoma
Answer:
Given the patient’s history of lung cancer and the development of low back pain along with numbness and tingling in the lower limbs, the most likely cause of his symptoms is metastases to the vertebral column.
Lung cancer commonly metastasizes to the spine, and vertebral metastases can cause back pain, nerve compression leading to radicular symptoms (such as numbness and tingling), and potentially spinal cord compression symptoms if the metastases are extensive.
Paraneoplastic syndromes associated with lung cancer can present with various neurological symptoms, but they are less likely to cause isolated low back pain with numbness and tingling in the lower limbs.
Muscular spasm of paravertebral muscles could cause low back pain, but it wouldn’t typically lead to numbness and tingling in the lower limbs.
Primary osteosarcoma of the spine is rare, and it would be less common compared to metastases from lung cancer in a patient with a known history of lung cancer.
The correct answer is B
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All the answers are correct and they cause back pain upper or lower but metastases to the vertebrae are the most common. A great question. Thank you dr Claude
How about paraneoplasm? Isn’t it a much likely cause of lower back pain, especially as there is numbness in the lower limbs?