Evolving metastasis in patients with chronic viral hepatitis as a cause of sciatic pain; pitfalls in diagnosis and management

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Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and an important cause of morbidity and mortality in patients with hepatitis C. The tumor usually metastasizes to the lungs, regional lymph nodes, and bone. Spinal cord compression secondary to metastatic disease as a first presentation is uncommon. Spinal surgery for degenerative spinal disc disease in patients with undiagnosed evolving HCC metastases that affect the outcomes was not previously reported. In this report, we presented three cases with chronic viral hepatitis treated at our department for spinal degenerative disc disease with the absence of radiological, clinical, and routine laboratory evidence of malignancy. Two patients were treated with surgery for spinal degenerative disc disease with unfavorable outcomes. The third patient was properly investigated for hidden metastasis and properly treated. Furthermore, we discussed the pitfalls of diagnosis and management of spinal degenerative disc disease in patients with chronic viral hepatitis without radiological and clinical evidence of evolving metastasis.