Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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C.H. Li et al.
Metastasis to the spinal canal or column can also manifest as groin
pain [ 41 ]. Similar to nerve sheath tumors, those lesions that involve the
lower thoracic or upper lumbar areas can cause nerve root compression
or irritation, which would be referred to the corresponding dermatome.
Such lesions typically seed into the vertebral body and can cause bony
destruction leading to pathological fractures and/or compression of neurological
structures. MRI with gadolinium contrast as well as CT of the
area can be helpful in making a diagnosis and identifying the lesion.
Treatment options in such patients must be weighed on a case-by-case
basis. Overall disease burden, prognosis, histology of the tumor, and the
general medical condition of the patient must be weighed given the
potential morbidity from surgery. In patients who are good surgical candidates,
surgery can be fairly effective in improving pain and neurological
function. Other treatments such as stereotactic radiosurgery, palliative
radiation, or palliative chemotherapy are additional options to consider
in this difficult patient population [ 41 ].
Summary
The differential for groin pain from spinal causes can be fairly extensive.
Presenting signs and symptoms can be helpful for identifying these
conditions, while MRI of the lumbar spine is a very effective diagnostic
tool for identifying any potential causes. Treatment for patients who
have identifiable pathology on MRI that correlates with their symptoms
can be fairly efficacious. Differentiating spinal and back pathologies
from inguinal etiologies is challenging, but the characteristics, distribution,
symptoms, signs, and imaging help to appropriately guide the
evaluation and subsequent therapy.
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