26th June 2023

A 63-year-old lady is sent to AMU by her GP after reporting a 3-month history of lethargy

A 63-year-old lady is sent to AMU by her GP after reporting a 3-month history of lethargy, back pain and 8kg weight loss. She is usually fit and well, working as a secondary school teacher full-time. She takes amlodipine for hypertension and vitamin D supplements from her local chemist. She attends yearly CT scans due to a history of breast cancer diagnosed when she was 48 and treated with chemotherapy and radical surgical clearance.

On examination, she has tenderness over T9 and T10 vertebrae, an antalgic gait, reduced power of 4/5 in both lower limbs and reduced range of motion on forward and lateral flexion.

Which of the following options is the most appropriate next step in her management?

Select the SINGLE most appropriate option from the list below. Select ONE option only.