This case report describes a diagnosis of spinal pain secondary to metastatic colon cancer, highlighting the need for close monitoring and an interdisciplinary approach for this cohort. An 82-year-old female presented with acute exacerbation of chronic low back pain with a rating of 7/10. She had a history of stage III colon cancer diagnosed 17 years previously and was currently in remission. Red flags included worsening pain after four days of oral analgesics and a history of cancer. Imaging revealed an osteolytic L5 vertebral lesion with endplate disruption, consistent with metastasis. She was urgently referred to an oncologist who ordered chemotherapy and radiotherapy. The metastatic spread of malignancy to the spine can manifest as new or progressive back pain and requires prompt diagnosis and management. Magnetic resonance imaging is recommended for the detection of osseous lesions and spinal cord compression. The case report serves as an educational tool for chiropractors in recognizing and managing spinal metastasis. By sharing this case report, healthcare professionals can learn from the experiences and challenges faced during the patient's care and apply that knowledge to their practice.