In their study, all patients with cancer had at least 1 of these 4 findings. The four clinical findings with the highest likelihood ratios for predicting cancer were a previous history of cancer, age 50 years and older, failure to improve with conservative therapy (having sought medical care within the past month and not improving), and unexplained weight loss of more than 10 pounds in 6 months. In that study, Deyo and Diehl 6 looked at 1,975 patients with a chief complaint of back pain who presented for care to the walk-in clinic of a public hospital only 13 (0.66%) of those patients were found to have cancer as the underlying cause. 9 However, only one large study has addressed the issue in a primary care population. Several strategies have been proposed for detecting spinal malignancy in patients with back pain and a known history of cancer 9, 11 these strategies may involve exhaustive testing to rule out spinal malignancy with a high degree of certainty. 9, 10 The ideal diagnostic strategy would detect the few cases of cancer among primary care patients with low back pain, while minimizing unnecessary diagnostic testing. 7, 8 Among patients who develop epidural spinal cord compression, those who are diagnosed early, while still able to ambulate, are the most likely to remain ambulatory following treatment.
6 An important goal of early diagnosis and treatment of spinal metastasis is to prevent complications, which may include pain, pathologic fracture, weakness, sensory loss, paralysis, and bowel or bladder dysfunction. 3, 5 Although malignancy is the most common of these systemic problems, 5 the prevalence of spinal malignant neoplasms (usually metastatic disease) among primary care patients with low back pain is less than 1%. 4Īn important goal of diagnostic testing is to identify the serious systemic causes of back pain, such as malignancy, infection, and inflammatory disease. 2 In the majority of cases of back pain, a specific diagnosis is not made, 3 and patients usually recover within a few weeks of the onset of symptoms. Low back pain is a common complaint among primary care outpatients estimates of the cumulative lifetime prevalence range from 13.8% for persistent pain 1 to as high as 80% for any episode of pain.
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