Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive axial spinal pain, localized to [Level/Region], associated with mechanical instability and nocturnal exacerbation. Denies constitutional symptoms of acute cord compression, including bowel/bladder dysfunction, saddle anesthesia, or progressive motor weakness. History of primary malignancy: [Primary Site]. Current pain score: [X]/10.
Clinical Examination Findings
Spine examination reveals midline tenderness to palpation at [Levels]. Range of motion is restricted secondary to pain. Neurological exam: Strength [X]/5 in bilateral lower extremities. Deep tendon reflexes are [Symmetric/Asymmetric/Hyperreflexic]. Sensory exam intact to light touch and pinprick. No clonus or Babinski sign observed. Gait is [Stable/Antalgic].
Treatment Protocol
Plan: 1. Multidisciplinary tumor board review. 2. MRI spine (T-spine/L-spine) with/without contrast to assess cord compression risk. 3. Initiate dexamethasone [Dose] if symptomatic. 4. Bisphosphonates/RANK-ligand inhibitors as indicated. 5. Consider palliative radiotherapy or surgical stabilization (decompression/instrumentation) based on SINS score. 6. Pain management optimization.