Spine Sign for Heart Disease

Atropy of the paravertebral musculature-the “spine sign”-in this 64-year-old man offers clues to the genesis of the coronary artery disease for which he had undergone a coronary artery bypass graft (CABG) and to the cause of his severe post-CABG anterior chest pain.

This patient had been treated with radiotherapy for a seminoma 30 years earlier. That treatment had involved the anterior and posterior fields of the retroperitoneum and mediastinum.

Dr Michael Zeihen of the Michael E. Debakey Heart Institute at Kenosha Hospital and Medical Center in Kenosha, Wis, comments that the spine sign suggests underlying cardiac disease and possible coronary artery disease in patients with a history of radiotherapy. Coronary artery, myocardium, and pericardium injury caused by radiotherapy is well documented in the literature.^1,2 An MRI scan to evaluate this patient's postsurgical pain found that the spinal cord was within normal limits, but electromyographic studies showed focal branch nerve injury to the paraspinal muscles. Physical therapy strengthened this patient's muscles and relieved the anterior chest pain. He was able to resume normal activities, including his beloved golf game.

REFERENCES:1. Om A, Ellahham S, Vetrovec GW. Radiation-induced coronary artery disease. Am Heart J. 1992;124:1598-1602.
2. Steward JR, Fajardo LF, Gillette SM, Constine LS. Radiation injury to the heart. Int J Radiat Oncol Biol Phys. 1995;31:1205-1211.