![]() Lower back pain has a lifetime prevalence of 85%, meaning that all physicians are likely to encounter patients who have this problem, but it is the presenting feature in an estimated 90% of patients with spinal malignancy. Urine dipstick was positive for protein 1+, leucocytes 3+ and nitrites 1+. The results of initial blood tests were all within normal limits: haemoglobin count (Hb) was 14.2, creatinine concentration was 48 μmol/l, white cell count (WCC) was 11.1, neutrophil count was 8.3 and C-reactive protein (CRP) was, 5 mg/l. Straight leg raising was, however, diminished to 10 degrees in the left leg and 40 degrees in the right leg. Otherwise her peripheral nervous system examination was normal with intact sensation to all dermatomes. Her power was reduced at the right hip flexor to 3+/5. Rectal examination revealed normal anal tone and no saddle anaesthesia. On admission, the patient's temperature was 36.8☌, blood pressure was 128/77 mmHg, pulse was 84 bpm and cardiovascular, respiratory and abdominal examination were unremarkable. A previous renal ultrasound scan had been normal. Her medications included prophylactic nitrofurantoin, diazepam and naproxen. Her medical history featured pyelonephritis (two and a half years previously) and a laparoscopic cholecystectomy. She also complained of dysuria and had recently completed courses of ciprofloxacin and nitrofurantoin. Symptoms of back pain at rest and urinary frequency had been persistent for five months and had been attributed to recurrent urinary tract infections. ![]() ![]() There was no tongue biting, headache or postictal confusion. She collapsed with loss of consciousness for a few seconds and was incontinent. At 8.30am she described the room spinning, but was unaware of any chest pain or palpitations. That morning, she had awoken with the pain but had managed to go to work. A 28-year-old woman presented with acute-on-chronic lumbar back pain. ![]()
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