PT Classroom - Spine Sign and Physical Therapy ׀ by Michael H. Zeihen, MD

Participation in physical therapy is a crucial part of the equation when trying to obtain the optimal level of success for my patients. In this case I was presented with a 64 y/o male patient who displayed atrophy of the paravertebral musculature and displayed a “spine sign”. The patient had undergone a coronary artery bypass graft (CABG) and had been experiencing severe post-CABG anterior chest pain. Patient also has a history of seminoma (testicular cancer) and had been treated for this condition 30 years ago. The treatment had involved the anterior and posterior fields of the retroperitoneum (abdominal cavity) and mediastinum (region in thorax).

The patient’s past medical history offered a clue to the patient’s cardiac condition. The term coined “spine sign” suggests underlying cardiac disease and possible coronary artery disease in patients with a history of radiotherapy. Damage to the coronary artery, myocardium, and pericardium as a result of radiotherapy is documented in literature and supports this finding (1,2).

Since the patient continued to experience anterior chest pain status post the CABG, a MRI was taken which found that the spinal cord was within normal limits. Further testing, utilizing electromyography, displayed a local branch nerve injury to the paraspinal muscles.

The patient was instructed to participate in physical therapy with a treatment plan which included: strengthening, core stabilization, stretching, postural training, functional training, electrical stimulation and patient education. Physical therapy was able to help the patient obtain relief from his anterior chest pain and return to recreational activities such as golf.