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What can be the cause of a prolonged back pain? What are the odds of it being cancer?

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My husband has had a bad back since beginning of January. He has been visiting an osteopath, and the pain has been easing somewhat. His G.P. sent him for a spinal x-ray yesterday, and today he had a call from the G.P. saying that she needed to see him on Friday. Does the speed of the results coming back mean that it is something sinister (cancer), or could it be something else
Posted Fri, 27 Apr 2012 in Back Pain
Answered by Dr. Prasad 20 hours later

Welcome to XXXXXXX forum.

Xrays is one of the basic tools of investigation used extensively by Orthopedician in evaluating bone illness. The findings are interpreted without difficulties by an expert.

If his doctor has called in for an early review, it doesn't necessarily mean he suffers from a severe illness such as a cancer. Other causes such as spondylosis/spondylitis are much more commoner than cancers.

The following details can help me in figuring the likely problem.

1. His age, current weight and height, the type of work he is involved in?
2. The location of the pain, low back or in the thoracic region?
3. Does he suffer from associated symptoms such as weakness of limbs; bladder and bowel disturbances; pain radiating down the limbs, reduced/loss of sensation in the legs?
4. Pain in any other joints?
5. Loss of appetite or loss of weight?
6. History of trauma before the onset of pain?
7. Did the pain start abruptly one fine day or did it gradually progress over days?

If you have the X XXXXXXX films with you, you may send me a scanned photocopy(taken on a digital camera) of it to YYYY@YYYY

Cancer involving the spine most often is a metastatic tumour. That is tumour spread from a different primary location. If your husband has been physically healthy and eating well, it is least likely that such metastatic tumour is the cause.

Awaiting your reply.

Best wishes
Above answer was peer-reviewed by
Follow-up: What can be the cause of a prolonged back pain? What are the odds of it being cancer? 2 hours later
Thank you Dr. XXXXXXX
We have been to see the G.P. today, who has had the results of the X-ray. It shows a total collapse of the 4th lumbar vertibra. The consultant thinks that this is probably caused by osteporosis, but has advised a scan to confirm this. (the reason for this is that my husband suffered from colon cancer 20 years ago, and they need to rule out the cancer).
My husband suffers from Parkinsons Disease and also ulcerative colitis, for which he takes numerous medications.
We have found some previious correspondence from a consultant, which shows that he had a DXA scan for bone density. This showed a slight reduction in bone density, but not enough to be classed as osteoporosis. This was in 2006. Could the bone density have deteriorated since then?. He was advised to take Calcichew tablets, which he is still on.
He also was a very heavy drinker some 18 - 20 years ago, - an alcoholic to be exact (but hasn't drunk since) and we have been given to believe that this too is linked to osteporosis.
While we try and think positively that this collapse of the vertibra has been caused by osteoporosis, we are still scared that it may be cancer.
If the scan shows osteoporosis, what happens next? Does it involve an operation, or is it something he has to learn to live with?
Many thanks,
Answered by Dr. Prasad 12 hours later

Thanks for following up with the useful information.

Is he on steroids for ulcerative colitis treatment?

Lumbar compression fractures/collapse are known to occur due to the following 3 causes

1. Osteoporosis
2. Chronic infections
3. Cancers - Metastatic tumors or multiple myeloma.

Based on the details provided, I concur with your doctor, that osteoporosis is most likely.

The following are the reasons why I consider osteoporosis
a. DEXA Bone densitometry scans done previous had suggested osteoporosis - there are possibilities that the condition may have deteriorated.
b. History of Ulcerative colitis - Ulcerative colitis is one of the risk factor of osteoporosis. The risks are even higher if he were to be on steroid treatment.
c. It is very unlikely that a cancer 30 years ago which was asymptomatic all this while to spread now. Though this can happen, most often such conditions present initially with recurrent fever, night sweats, reduced appetite and loss of weight

All these features point towards osteoporosis.

This can be very well proved by the scans. Hence I recommend you to get the scans done.

Though this is not good news; osteoporosis is a chronic condition and may not be curable. He probably may need to be on medications for a long, long time. Surgery (vertebroplasty) may be needed if the lumbar collapse is severe with unbearable symptoms.

Wish him Good Health.
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