Disclosures: Anupam Sinha, DO: Nothing to disclose

Case Description: Patient presented with complaints of 4 weeks of neck and low back pain. He denied any injury. The pain radiated into the right shoulder and also down the right leg. Treatment had included two visits to the emergency room, as well as oral steroids, cyclobenzaprine, hydrocodone, and gabapentin, which gave him minimal relief. He denied bowel, bladder, or balance complaints.

Setting: Orthopedic Practice

Patient: 62-year-old male, current smoker

Assessment/Results: Physical examination revealed severely reduced, painful cervical spine and lumbar spine range of motion. Normal neuromuscular exam. No upper motor neuron signs. MRI of the cervical spine from 5 years ago was reviewed, showing C5-C6 disc herniation and degenerative changes at C6-C7. MRI of the cervical spine was ordered showing a 3-cm lesion eroding the posterior elements of C2 highly suspicious for neoplasm. MRI of the lumbar spine showed neoplastic involvement involving L2 and the right sacroiliac region. Nuclear bone scan showed abnormal uptake at C2, L2, multiple ribs, sternum, and pelvis. CAT scan of the chest, abdomen, and pelvis revealed a 2cm × 3cm mass at the right lung apex. Patient was referred to oncology for further management of metastatic lung cancer.

Discussion: Roughly 30 to 40 percent of patients with advanced lung cancer have bone metastases. The cervical region is affected in 10% of cases of spinal metastases. The most common symptom of bone metastases is pain. Often the pain begins gradually, feeling like a muscle pull or strain, and progresses to more severe pain. Due to weakening of the bone from the tumor, some patients develop pathological vertebral fractures that can occur with minimal trauma.

Conclusion: We present a case of metastatic lung cancer with the unusual presenting symptom of cervical pain. Clinicians should routinely image the chest in patients who are long term smokers to screen for early signs of lung cancer.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/metastatic-lung-cancer-presenting-as-neck-stiffness-a-case-report/