Chih Yu-Pin, Wu Wei-Ting, Lin Chien-Lin, Jou Herng-Jeng, Huang Yu-Hsuan, Chen Liang-Chi, Chou Li-Wei
From the Department of Physical Medicine and Rehabilitation, China Medical University Hospital (Y-PC, WTW, C-LL, Y-HH, L-WC); School of Chinese Medicine, College of Chinese Medicine, China Medical University (C-LL, L-WC); Department of Orthopedic Surgery, Kuang Tien General Hospital (H-JJ); Department of Nursing, Hungkuang University (H-JJ); and Department of Pathology, China Medical University Hospital (L-CC), Taichung, Taiwan.
Medicine (Baltimore). 2016 Feb;95(5):e2670. doi: 10.1097/MD.0000000000002670.
Compression fracture of the vertebral body is common in the older patients. The possible etiology like osteoporosis or cancer metastasis should be included as a possibility in the differential diagnosis for severe back pain, to prevent delays in diagnosis and treatment. More severe fractures can cause significant pain, leading to inability to perform activities of daily living, and life-threatening in the older patient.We report a rare case of a 61-year-old man suffering from severe lower back pain and intermittent abdominal fullness. He came to our clinic, where muscle power was normal, but could not stand up or change posture because of severe back pain. Plain film and magnetic resonance imaging of lumbar spine both revealed osteoblastic lesion at L2 spine. Abdomen computed tomography showed a mass at the pancreatic body. The pancreatic cancer with osteoblastic metastasis was diagnosed. After receiving multimodality therapy such as percutaneous vertebroplasty and pain controlling, we provided effective palliation of symptoms, aggressive rehabilitation program, and better quality of life.Our case highlights the benefits of multidisciplinary cancer treatment for such patient, preventing the complications such as immobilization accompanied with adverse effects like musculoskeletal, respiratory, and cardiovascular systems. All clinicians should be informed of the clinical findings to provide patients with suitable therapies and surveys.
椎体压缩性骨折在老年患者中很常见。在严重背痛的鉴别诊断中,应将骨质疏松症或癌症转移等可能的病因考虑在内,以防止诊断和治疗延误。更严重的骨折会导致严重疼痛,导致老年患者无法进行日常生活活动,甚至危及生命。我们报告一例罕见病例,一名61岁男性,患有严重的下背痛和间歇性腹胀。他来到我们诊所,肌肉力量正常,但由于严重背痛无法站立或改变姿势。腰椎X线平片和磁共振成像均显示L2椎体有成骨病变。腹部计算机断层扫描显示胰体有一个肿块。诊断为胰腺癌伴成骨转移。在接受了经皮椎体成形术和疼痛控制等多模式治疗后,我们有效缓解了症状,实施了积极的康复计划,并改善了生活质量。我们的病例强调了多学科癌症治疗对这类患者的益处,预防了诸如因肌肉骨骼、呼吸和心血管系统等不良反应而导致的固定不动等并发症。所有临床医生都应了解这些临床发现,以便为患者提供合适的治疗和检查。