title: Thoracic spine spasms secondary to hemorrhagic intestinal ulcer.
abstract: A case of thoracic spine spasms secondary to a bleeding duodenal ulcer is presented. A 41-year-old male with 14-week history of thoracic spine spasm was treated with bed rest, spinal manipulation, physical therapy, medication, and a thoracolumbar brace. Subsequently, a provocative thoracic discogram performed at T9-T10 created periscapular pain and also reproduced the presenting thoracic spasms. Intradiscal electrothermal annuloplasty (IDET) was performed at the T9-T10 level, but without sustained relief. The patient presented to a spine center for evaluation. The diagnosis of thoracic discogenic disease was suspected. A second provocative thoracic discogram was performed and failed to reproduce his thoracic spasms. Three weeks after being referred to a chronic pain management physician, the patient presented to a local emergency room with hema-temesis. An endoscopic evaluation revealed a bleeding duodenal ulcer. Following medical treatment of the duodenal ulcer with a proton pump inhibitor the patient had complete resolution of his thoracic spasms. This represents the first reported case of thoracic spine spasms as an initial presenting symptom of a bleeding peptic ulcer.
authors.affiliation: The Penn Spine Center, Ground Floor White Bldg., 3400 Spruce St., Philadelphia, PA 19104, USA. slipman@mail.med.upenn.edu
authors.forename: C W
authors.initials: CW
authors.lastname: Slipman
authors.forename: W S
authors.initials: WS
authors.lastname: Whyte Ii
authors.forename: G R
authors.initials: GR
authors.lastname: Lichtenstein
authors.forename: D
authors.initials: D
authors.lastname: Lenrow
authors.forename: D
authors.initials: D
authors.lastname: Braverman
authors.forename: M
authors.initials: M
authors.lastname: Ellen
authors.forename: E J
authors.initials: EJ
authors.lastname: Vresilovic