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Spinal pain is frequently encountered in pain clinics and is often attributed to benign musculoskeletal conditions; however, serious underlying diseases may present with similar symptoms, leading to diagnostic challenges. We report two cases that illustrate clinical pitfalls in interpreting spinal magnetic resonance imaging (MRI) in patients with cervicothoracic pain. The first case involved a 60-year-old man presented with persistent posterior neck and upper back pain accompanied by weight loss and sleep disturbance. On the outside cervical spine MRI, the lesion was overlooked because it was located beyond the primary region of interest on the far lateral sagittal images; subsequent chest computed tomography (CT) revealed a Pancoast tumor. In the second case, a 64-year-old man was referred for a bone biopsy after multifocal signal alterations on spinal MRI were interpreted as suspicious for malignancy at a primary clinic. However, the biopsy revealed only reactive marrow changes, and his symptoms improved after a cervical epidural block. These cases demonstrate that while MRI is indispensable in the evaluation of spinal pain, it should not be considered definitive without careful clinical correlation. Thorough history-taking, vigilance regarding red flags, and careful review of all imaging planes and adjacent anatomical structures are essential to avoid delayed diagnosis or unnecessary invasive intervention in pain clinic practice.
Jiwon Yoon [ 윤지원 | Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea ]
Dongsik Lim [ 임동식 | Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea ]
Pyung-Bok Lee [ 이평복 | Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea/ Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea ]
Corresponding Author