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Answer 20-15. Metastatic tumor of the spine often result first in back pain (that may persist even at rest), with subsequent signs of acute or subacute myelopathy (initially flaccid weakness, upgoing toes, sensory level over the trunk, bladder and bowel dysfunction), possible radiculopathy at the level of the tumor. The level of back pain and the radiculopathy are the most predictive of the location of the tumor.