Breast cancer with osseous metastasis and herniated lumbar disc. A cautionary tale

A 39-year-old white woman with breast cancer, metastatic to her skeleton, developed low back and left lower extremity pain and lower extremity weakness. A bone scan evidenced increased radioisotope activity in her lumbar spine and a computed tomography (CT) scan showed a lesion of the L4 vertebrae. Because of myelographic findings of an extradural defect at the L4-5 disc space and the possibility of a herniated disc causing the patient's pain and neurologic deficit in her lower extremities, the patient underwent surgery and a large herniated L4-5 disc was removed. As a consequence, the patient experienced relief of the lower extremity pain and return of strength in her lower extremities. She died a considerable time later from refractory hypercalcemia.