1.5 SFGH AM pearls – Spinal imaging and bony mets!

  • From the ditty: Radiation to the intima of the coronaries triggers a cascade similar to atherosclerosis, with myofibroblast activation and platelet deposition. Even though the actual plaques may be more fibrinous that typical atherosclerotic plaques, the general pathophys and outcomes are similar for XRT-induced CAD.
  • While we use “red flags” to assess the need for advanced imaging (usually MRI) for low back pain, only a history of cancer increases the chances that malignancy will be found on imaging
    • Other indications for advanced imaging include high suspicion of infection and severe neuro deficits with symptoms of cord involvement
    • Plain films can be obtained if compression fracture is suspected, and risk factors for this include age >70, significant trauma, or minor trauma on patient with osteoporosis
  • For any patient with known malignancy who presents with progressive back pain, contrast-enhanced MRI in indicated, even in the absence of neurologic signs
    • Once spinal pathology has been evaluated and a treatment plan is in place (evaluation for surgical intervention, pain control, etc), plans for search for other bony mets can be made, which depend on the primary cancer
    • The need for biopsy depends on whether imaging is sufficient for diagnosis and whether definite pathology will change management.
  • Throwback Tuesday to a mnemonic we sent out earlier this year to help remember which malignancies tend to cause bony mets: BLT Sandwich with a Kosher Pickle and Light Mustard and Mayo

o   Breast, Lung, Thyroid, Sarcoma, Kidney, Prostate, Lymphoma, Myeloma and Melanoma

spine imaging

Evernote link: https://www.evernote.com/shard/s300/sh/36845541-3588-44c0-949d-c421a07b5933/b8adfceff31c22781315010b74000f3d

Hooten WM, Cohen SP. Evaluation and Treatment of Low Back Pain: A Clinically Focused Review for Primary Care Specialists. Mayo Clin Proc 2015; 90:1699.

Downie A, Williams CM, Henschke N, et al. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ 2013; 347:f7095.

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