Metastatic Recurrent Breast Cancer Identified in the Chiropractic Office: Case Report and Literature Review

Abstract

BACKGROUND Breast cancer is the most common cancer in women and the most common cause of spinal metastasis, and it may recur months to years after treatment. CASE REPORT A 41-year-old woman, recovered from breast cancer, presented to a chiropractor with acute-on-chronic 3-week history of low back pain radiating to the right leg. She had seen 2 providers previously; lumbar spondylosis had been diagnosed via radiography. Given her recent symptom progression and cancer history, the chiropractor ordered lumbar magnetic resonance imaging, revealing L5 vertebral marrow replacement, suggestive of metastasis. The chiropractor referred her to an oncologist. While awaiting biopsy and oncologic treatments, the oncologist cleared the patient to receive gentle spinal traction and soft tissue manipulation, which alleviated her back pain. The patient continued radiation and chemotherapy, with low back pain remaining improved over 18 months. A literature review identified 7 previous cases of women presenting to a chiropractor with breast cancer metastasis. Including the current case, most had spinal pain and vertebral metastasis (75%) and history of breast cancer (88%) diagnosed a mean 5±3 years prior. CONCLUSIONS This case illustrates a woman with low back pain due to recurrent metastatic breast cancer, identified by a chiropractor, and the utility of a multidisciplinary approach to pain relief during oncologic care. Our literature review suggests that although uncommon, such patients can present to chiropractors with spinal pain from vertebral metastasis and have a known history of breast cancer. Conservative therapies should be used cautiously and under oncologic supervision in such cases.

Figure 1.

Timeline of care. MRI – magnetic resonance imaging; PET/CT – positron emission tomography computed tomography.

Figure 2.

Lumbar spine magnetic resonance imaging. T1-weighted (A) and fat-suppressed T2-weighted (B) mid-sagittal views, showing marrow replacement of the entire L5 vertebral body, indicated by an abnormal heterogenous T1-weighted hypointense, T2-weighted hyperintense marrow signal change (arrows). The marrow change also extends into the right L5 pedicle (not shown).

Figure 3.

Demonstration of mechanical traction (MID spine decompression device, WIZ Medical, Korea).

Figure 4.

Administration of instrument-assisted soft tissue manipulation. The practitioner applies a thin layer of emollient/lotion to the patient’s skin then gently strokes the massage tool (Strig, Korea) across the skin surface (arrows).

Figure 5.

Intra-procedural axial section of the computed tomography-guided biopsy of the L5 vertebra.

Figure 6.

Demonstration of gluteal bridge exercise. The patient begins supine with the back flat against the table, then raises the back and hips to the elevated position shown.