History of Present Illness: A 66 year old male from Naga City was admitted for the 3rd time for recurrent low back pain. His illness started 24 years PTA when he fell from a height of 3 ft. sustaining a closed right calcaneal fracture. One year later, he started to have low back pain, diagnosed as osteoarthritis by a private physician. He was given Phenylbutazone which induced upper GI bleeding. He was then confined for the first time a year after for blood transfusion and control of bleeding. At home, he self-medicated with corisorprodal-phenylbutazone which afforded intermittent temporary relief, so he did not return for follow up. 11 yers PTA, back pain became severe enough to limit ambulation. Thoracolumbar area X-ray showed lytic changes, superior aspect of L2 vertebral body, narrowed disc space between L1 and L2; the rest of the lumbar area exhibited hypertrophic osteoarthritic changes. Chest X-ray showed no significant findings. He was given Indomethacin, antacids, megavitamin B and fitted with chairback brace. The AP film taken a month after shows an increase in the transverse diameter of the heart, pulmonary congestive changes in the hilar area and hazy infiltrates in the infraclavicular area of the right upper lobe. Small nodular densities are noted in both lung fields. The 8th rib on the right shows lytic changes. X ray of the lumbar spine shows osteophyte formation in L3 and L4. The rest of the spine was negative. 2 weeks PTA, he accidentally hit his buttocks on a low chair. His back pains rapidly worsened, prompting his 3rd admission. Past Medical History: * Flame burns of the right upper extremity at 31 years of age. * Bilateral operation for glaucoma at 53 years of age * Recurrent attacks of fever and dysuria with long standing hesitancy of voiding Family HIstory * Negative for PTB Personal and Social History * He is a retired mechanic who does not smoke nor drink alcoholic beverages. Physical Examination and Course in the Ward PE on admission revealed that was not in cardiorespiratory distress by stretcher-borne. Vital signs were unremarkable. There were no abnormal findings in the heart, lungs and abdomen. Examination of the back revealed (+) CVS tenderness on the right, (+) slight tenderness over L1 and L2 intervertebral joint, and (+) limitation of the range of motion of the hip joint. Rectal examination revealed good sphincteric tone by the prostate was lightly and firmly enlarged. Neurological examination showed the cranial nerves to be intact without sensory deficits, Motor power on both upper extremities was 5/5, the lower extremities was grade 4/5 which was attributed to the back pains. There were no pathologic reflexes nor autonomic system abnormalities. ECGT showed regular sinus rhythm and right ventricular hypertrophy. Cone view of the lumbar spines showed one of the L2 pedicles to be indistinct. Skeletal survey revealed no additional changes. SGPT, SGOT, serum amylase, bilirubin, BUN, creatinine, total protein, CBC and urinalysis were requested. KUB-IVP showed organo-axial rotation of the right kidney, however there seemed to be no mass displacing the right kidney. Thyroid scan showed symmetrically enlarged thyroid glands with even uptake. Bone biopsy of the posterior iliac was also performed. In the ward, he refused to ambulate for fear of exacerbation of his back pain. On the 14th hospital stay, he underwent TURP, cystoscopy and meatotomy. The film taken on the 30th hospital day showed lytic destructive lesions affecting the body of the L1 and L2. There are no mass lesions or associated mass densities besides the vertebral pathology. The disc space is obliterated. Several days post-op, he was still dysuric and hematuric. Urine culture showed confluent growth of Pseudomonas. He was given Piperacilliin and his urine became sterile after 10 days. Meanwhile, his back pain worsened, requiring parenteral narcotic analgesic for relief. An equivocal lytic lesion was noted on a rib by one consultant but no biopsy was done. On the 34th hospital day, Cessium radiotherapy 570 rads daily for 17 days was applied to the thoraco-lumbar area. After 5 days, he was able to turn from side to side. Repeat cone view showed the L2 pedicle to have disappeared. On the 46th hospital day, he had fever, hematuria and dysuria. He was placed on complete bed rest, so radiotherapy was suspended. Urine culture showed confluent growth of E. coli and he was given Amoxicillin. Repeat culture after 10 days showed over 100,000 colonies of Klebsiella sp. Per ml. Tobramycin was started. He became afebrile and passage of large blood clots per urethra stopped. However, he has urinary incontinence when the Foley catheter was pulled out. Radiotherapy was resumed on his 51st hospital day and was completed on the 56th. No additional significant pain relief was noted with resumption of radiotherapy. On the 61th hospital day, he was being prepared for repeat KUB-IVP. Three hours later, he was found to be severely dyspneic with harsh breath sounds over both lungs. Heart sounds were indistinct. Resuscitative measures failed.