An Unusual Spine Care Diagnosis: The Value of Multidisciplinary Comprehensive Spine Centers

Background: Comprehensive spine centers (CSCs) offer multidisciplinary care, with input from various specialists, including spine surgeons, physiatrists, pain physicians, chiropractors, and therapists to improve care in patients with spinal pathology. Methods: A 62-year-old female with history significant for remote cervical spine fusion and chronic low-back pain due to left sacroiliac joint dysfunction and lumbosacral spondylosis status post recent L3-L5 laminectomy and fusion, presented to a CSC for evaluation of increased right-sided nociceptive back pain after hearing an audible "snap." Results: Examination was notable for tenderness to palpation over the lumbosacral paraspinals and the right sacroiliac joint, reproduction of mild axial low back pain with extension and left flexion abduction external rotation (FABER) test. Advanced imaging revealed no pseudoarthrosis involving the instrumented lumbar spine levels, though incidentally noted multiple prominent and borderline enlarged lymph nodes in the right supraclavicular and superior paratracheal regions. Computed tomography (CT) scan of the neck and chest re-demonstrated indeterminate lymphadenopathy. Excisional lymph node biopsy revealed early-stage follicular lymphoma (FL). Conclusion: This case highlights the ability of comprehensive spine centers to make surprising diagnoses through comprehensive assessments of patients with complex spinal abnormalities as part of a multidisciplinary model of care.