LUMBOSACRAL RADICULOPATHY SECONDARY TO L5 METASTATIC MELANOMA OF UNKNOWN PRIMARY

Lumbosacral radiculopathy secondary to spinal malignancy is rare. Spin al melanoma without cutaneous manifestations is even more unusual. We present the case of a 45-year-old physician with a history of degenera tive disease of lumbar spine and chronic back pain who presented with increasing back pain with right radiculopathy despite conservative man agement for 6 months. Computed tomography showed a destructive lesion of the L5 vertebral body. Results from a biopsy guided by computed tom ography suggested neoplasm of unknown origin. The patient underwent an terior vertebrectomy with instrumentation and fusion. Surgical patholo gy study results showed metastatic melanoma of unknown primary. The pa tient had no cutaneous manifestation of the disease. This is the first reported case of radiculopathy due to melanoma metastatic to the lumb ar spine. In view of the atypical presentation of our patient's malign ancy, we emphasize the importance of including malignancy of lumbar sp ine in the differential diagnosis of progressive lower back pain with radiculopathy. (C) 1996 by the American Congress of Rehabilitation Med icine and the American Academy of Physical Medicine and Rehabilitation