Symptomatic spinal metastases.

Pain is the earliest and most prominent feature of symptomatic spinal metastases. In some cases, pain may have been present for months and dismissed as arthritis or back strain. Local back or neck pain occurring in a cancer patient is due to spinal metastasis until proved otherwise. Once weakness occurs, the disease progresses to paraplegia unless treatment is undertaken. Pedicle erosion is the most common abnormality on spinal films. Irradiation is often effective, but surgery is indicated for radiation failure, unknown diagnosis, pathologic fracture-dislocation and rapid disease progression.