Back Pain

Symptomatic therapy

High-dose dexamethasone

Surgery followed by radiation therapy or radiation therapy alone

Symptomatic therapy +/- radiation therapy

Symptomatic therapy

End

Neurologic exam

Normal

Suspicious for myelopathy

MRI of spine

Epidural metastases

Bone metastases but no epidural metastases

No metastases

Normal

Abnormal

Plain spine x-ray

Pain crescendo pattern

Lhermitte’s sign

Pain aggravated with cough,

Valsalva, and recumbency