Perspectives on orthopaedics

Back pain suggesting malignancy or inflammatory disease

John PH Stephen



A 65-year-old man presents with persistent back pain that has worsened over a period of months and extends into his buttocks and thighs. What are the diagnoses to consider and how should he be investigated?

Article Extract

Case presentation

A 65-year-old man presents with persistent low lumbar back pain. The pain has been present for a few months and has gradually worsened. It troubles him persistently each night and he cannot find a comfortable position in bed. The pain radiates into both buttocks and both thighs, but he has no true radicular symptoms.

On examination, his lumbar movements are quite markedly restricted by pain. He is tender in the midline in the low lumbar region. Straight leg raising is restricted by back pain rather than leg pain. He has no neurological signs.