Case presentation A 75-year-old woman reported to the outpatient clinic with lower back pain (visual analog scale [VAS] 8/10) along with progressive weakness in lower limbs. She also had urinary complaints of trouble initiating micturition and incontinence.

Clinical examination Axial tenderness in the lumbar spine Paraspinal muscle spasm Neurological investigation  Bilateral tibialis anterior power - 3/5 Extensor hallucis longus - 3/5 Hypoesthesia in the saddle and perineal region   Radiological findings                                                                                           Source: Journal of Orthopedic Case Reports Figure 1. Positron emission tomography-computed tomography (PET-CT) of (a) left proximal femur, and (b) L2, and (c and d) vertebra with increased F-fluorodeoxyglucose (FDG) activity (shown with arrows) X-ray of pelvis and both hips (PBH), anteroposterior…