Figure 2 Spinal metastasis. This 53-year-old woman with a remote history of breast cancer presented to a chiropractor with a 3-month history of progressively worsening low back pain with radiation into the lower extremities bilaterally and lower extremity weakness. She previously presented to the emergency department and had been referred for physical therapy. Lumbar magnetic resonance imaging showed several findings consistent with bony metastasis, including lesions of the sacrum and ilium (arrows in T2-weighted coronal image), liver, and lumbar spine. The patient was referred to an oncologist for further management. Arrows added by RT using GNU Image Manipulation Program (Version 2.10.30).