Introduction
Thoracic and lumbar spinal pain are 2 common complaints that patients present to the clinical chiropractic setting and are seen every day by various practitioners.1 It is relatively uncommon that low back pain represents a serious disease, but metastatic disease can present as low back pain, especially in patients with a history of carcinoma. It is these unique cases that the clinician must be wary of, in which common mid-back and low back pain represents a more serious pathologic condition, especially when the pain seems reticent to reliable and proven conservative care.
It is estimated that more than 85% of acute low back pain can be categorized as nonspecific, which includes lumbar strain and sprain, degenerative disk or facet process, and spinal stenosis or spondylolisthesis. Less than 5% is pathologic in origin, including neoplasia, infection, inflammatory arthritis, and visceral disease.2 It is these rare but extraordinary cases that can easily slip by the clinical practitioner until the symptoms are so severe they are impossible to ignore.
Approximately 5% to 6% of women with breast cancer present with distant spread, with bone representing the most common site of metastatic lesions. The risk of developing bone metastasis 10 years after initial diagnosis is 7% to 9%.3 It is imperative that clinicians be able to detect any clues in the patient’s history and physical examination to afford an early recognition of possible spinal metastasis and give the patient the best chance of survival. It is the purpose of this case report to describe the discovery of such a case in a seemingly healthy and active middle-aged athletic patient.