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Severe neck pain. MRI done. Family history of cancer. Should I go for bone marrow biopsy?

Dec 2012
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Answered by

General & Family Physician
Practicing since : 2012
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I have been having severe pain in my neck, along my spine, and down my right arm. I had a MRI two years ago that should buldging disc c4-c-7. I went to physical therapy and it helped. For the past 8 months to a year the pain is back and is more severe. I am also having night sweats, low grade fever, extreme fatigue, and just achy all over. I have extreme pain at least 3-4 nights a week. I had my second MRI done two weeks ago and showed no change in my buldging disc, however, it showed abnormal bone marrow signals. They sent me to get a bone scan and it came back normal. I'm not satisfied stopping here because of the family history of cancer on both sides of my family. Also, the pain is not being relieved with any medications or PT. what would the next step be? Bone marrow biopsy? PET scan?
Posted Sun, 24 Feb 2013 in Bones, Muscles and Joints
Answered by Dr. Nsah Bernard 2 hours later

Thank for posting on HCM
I will like to start by saying I agree with you on the fact that the investigations should be continued until the cause of the affection is discovered. From your description of your condition, I immediately thought of 3 main possible causes: chronic infection, autoimmune diseases (probably hereditary) and tumor (probably malignant/cancerous). The fact that any lesions have not been detected on the scans does not mean there is no existing lesion. Let be more clear on my impressions.
Chronic infection could be chronic spondyloarthritis/Spondyloarthropathy ( infection of the vertebral column + spine, in your case the cervical vertebrae and spine). To determine, you will require imagery studies such as MRI, CT scan, PET scan, lumbar puncture for CSF analysis, blood tests to detect inflammatory responses (TNF-alpha, CRP, ESR etc) and others etc. In visage of infection we could also think of Pott's disease/spinal TB (especially given your symptoms of night sweats, fever, fatigue etc). Specific tests to determine presence of TB need to be done ( including CSF analysis, X-ray or CT scan).
Other possible cause is ankylosing spondylitis (an autoimmune diseases) is an autoimmune disease involving the spine and sacroiliac joints, and is therefore also a form of spondylarthritis ( no specific diagnostic tool, above tests need to be done). Specialist consultation with a rheumatologist is advisable.
Last impression is tumor (could be benign but usually malignant given your symptoms). Same tests need to be conducted. You need to see either a rheumatologists or an oncologist. You can envisage to do an AMAS tests (anti-malignin antibody in serum) used to detect presence of Cancer any where in the body. Given your past family history, it is possible you are developing cancer. Biopsy will be necessary.

All of the above condition could explain resistance of pain to medications or physiotherapy.
The specific conditions need to be treated with specific medications hence reason for accurate determination of cause.

Hope this helps and write back for further clarifications
Dr Nsah
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