title: A 69-year-old presenting with musculoskeletal low back pain: a case of lumbosacral chordoma.
abstract: OBJECTIVE
  The purpose of this case report is to describe the presentation of a patient with lumbosacral chordoma characterized by somatic chronic low back pain and intermittent sacral nerve impingement.
  
  
  METHODS
  A 69-year-old male presenting to an emergency department (ED) with low back pain was provided analgesics and muscle relaxants then referred for a series of chiropractic treatments. Chiropractic treatment included manipulation, physical therapy, and rehabilitation. After 3 times per week for a total of 4 weeks, re-examination showed little relief of his symptoms. His pain symptoms worsened and he presented to the ED for the second time. Magnetic resonance imaging was performed and revealed a high intensity mass.
  
  
  RESULTS
  The soft tissue mass identified on magnetic resonance imaging was surgically removed. Shortly after the surgery, the patient developed post-operative bleeding and was returned to surgery. During the second procedure, he developed a post-operative hemorrhage related to the development of disseminated intravascular coagulation and subsequently died during the second procedure. A malignant lumbosacral chordoma was diagnosed on pathologic examination.
  
  
  CONCLUSIONS
  This case report describes the presentation of a patient with lumbosacral chordoma presenting with musculoskeletal low back pain. Chordomas are rare with few prominent manifestations. An early diagnosis can potentially make a difference in morbidity and mortality. Due to its insidious nature, it is a difficult diagnosis and one that is often delayed.
authors: Associate Professor, Department of Health Professions, CUNY, York College, Jamaica, NY.
authors: Shawn P
authors: SP
authors: Williams
authors: Associate Professor, Department of Health Professions, CUNY, York College, Jamaica, NY.
authors: Bernard
authors: B
authors: Beckerman
authors: President, Nightingale Medical Supply Company Inc., Queens, NY.
authors: Maria Elena
authors: ME
authors: Piña Fonti
keywords: Chiropractic; Chordoma; Low back pain; Lumbosacral region