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 Scans Metastasis at T5, T8 and L1, with bulging at T5. ? Left Hip pain referred from L1 area No known Primary Treated by radiotherapy.