Metastatic lung squamous cell carcinoma with T3 vertebral fracture responding to treatment

What happened, in summary

A 64-year-old Japanese woman with no major prior medical history developed back pain, followed by progressive numbness and weakness in her lower body and worsening gait. On examination, she had reduced sensation below the T5 level and mild weakness in the right leg, but no bowel or bladder dysfunction. Thoracic spine X-ray showed signs of a T3 compression fracture, while chest imaging showed an infiltrative shadow in the right lower lung field. CT and MRI confirmed a pathologic fracture of the T3 vertebra with lytic change, spinal cord compression, and adjacent soft-tissue signal abnormality. Enhanced CT supported the diagnosis of a metastatic thoracic spine tumor arising from a primary lung cancer. Bronchoscopy biopsy of the right lower-lobe lung lesion confirmed squamous cell carcinoma of the lung. Her spinal disease was clinically important because the fracture and cord compression explained her numbness, weakness, and gait disturbance. Prognostic scoring estimated a 68% 1-year survival rate and 55% 2-year survival rate, and the Spine Instability Neoplastic Score indicated mild instability. Treatment combined local spine support and cancer-directed therapy. She used a cervicothoracic brace, received radiation therapy to the T3 vertebral metastasis, and was treated with denosumab and osimertinib. Digital tomosynthesis was used to follow the upper thoracic lesion, where standard radiographs can be difficult to interpret because of shoulder overlap. Imaging 2 weeks after admission showed the lytic lesion, while follow-up at 16 weeks showed bone sclerosis, indicating response. She remained neurologically intact, her spinal stability improved enough for care de-escalation, and she was able to stop using the brace.