Case 14 Spinal Metastasis

Figure 14.1: MRI and CT of the patient: A CT sagittal spine, B MRI T2, C T1 with and without contrast, D Axial with contrast.

Clinical presentation

• Female patient 48 years with 3 months history of ago neck pain associated with Bilateral brachialgia of diffuse dermatomal distribution more on the left upper limb.
• 3wks ago pt developed left UL weakness followed by Right UL weakness more at hands within the last 3 weeks.
• There is a history rectal carcinoma excision followed by radiotherapy and chemotherapy in the previous year.
• On examination there is bilateral finger drop with weakness in finger extension grade 1/5 and 2/5 on the right and left respectively, otherwise patient is full power.

• Q1: What are the main movements of the upper limb with root value and nerve supply?

Movement	Nerve root	Peripheral nerve
Shoulder abduction	C5	Axillary
Elbow flexion	C5-6	Musculocutaneous
Elbow extension	C6-7	Radial
Wrist extension	C6-7	Radial
Wrist flexion	C7-8	Median
Finger flexion	C8	Median
Finger extension	C8	Radial
Finger abduction	C8	Ulnar

• Q2: What is the differential diagnosis of the radiological finding?
• It includes the following:

1. Osteoporosis
2. Neoplastic lesion (Metastasis, and 1ry bone tumours)
3. Infection
4. Chronic renal failure
5. Avascular necrosis of the vertebral body (with steroid use)
6. Vertebrae plana

• Q3: What is the NOMS algorithm for spinal metastasis?

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