Back pain Medical Question

Back pain Medical Question

A 71-year-old man comes to the emergency department with worsening back pain for the past 4 days. He underwent surgery for advanced prostate cancer 7 months ago. He states that he has fallen 4 times since yesterday due to imbalance. The patient’s temperature is 37C (98F), blood pressure is 125/82 mmHg, pulse is 84/min and respirations are 17/min. On physical examination his lower extremities strength is 4/5 bilaterally with mild spasticity and 3+ deep-tendon reflexes. Rectal sphincter tone is weak. He has point tenderness over the L5 & S1 region. Which of the following is the most appropriate next step in management of this patient?

Elderly patient with back pain

A- Leuprolide
B- X-ray of lumbar spine
C- IV glucocorticoids
D- NSAIDs and baclofen
E- Radionuclide bone scan





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[sociallocker]Correct answer is C. Patient’s presentation suggests epidural spinal cord compression (ESCC) from malignancy. Common metastatic malignancies affecting the spine are lung, breast, prostate cancer and multiple myeloma. Rapid recognition of ESCC is vital to avoid permanent neurologic complications. MRI of the spine is recommended for initial evaluation, however treatment with IV glucocorticoids must be initiated while awaiting for imaging studies. Glucocorticoids decrease vasogenic edema caused by obstructed epidural venous plexus & help alleviate pain & restore neurologic function.[/sociallocker]