LOW BACK PAI N

Question 1

45 yo F presents with low back pain that
radiates to the lateral aspect of her left
foot. Straight leg raising is positive. The
patient is unable to tiptoe.

Answer 1

Disk herniation
Lumbar muscle strain
Tumor in the vertebral canal

XR—L-spine
MRI—L-spine

Question 2

45 yo F presents with low back pain that
started after she cleaned her house. The
pain does not radiate, and there is no
sensory defi cit or weakness in her legs.
Paraspinal muscle tenderness and spasm
are also noted.

Answer 2

Lumbar muscle strain
Disk herniation
Abdominal aortic aneurysm
Vertebral compression fracture

XR—L-spine

Question 3

45 yo M presents with pain in the lower
back and legs during prolonged standing
and walking. The pain is relieved by
sitting and leaning forward (e.g., pushing
a grocery cart).

Answer 3

Lumbar spinal stenosis
Lumbar muscle strain
Tumor in the vertebral canal
Peripheral vascular disease

XR—L-spine
MRI—L-spine
(preferred)
CT—L-spine
Ankle-brachial index

Question 4

17 yo M presents with low back pain that
radiates to the left leg and began after he
fell on his knee during gym class. He also
describes areas of loss of sensation in his
left foot. The pain and sensory loss do not
match any known distribution. He insists
on requesting a week off from school
because of his injury.

Answer 4

Malingering
Lumbar muscle strain
Disk herniation
Knee or leg fracture
Ankylosing spondylitis

XR—L-spine/knee
MRI—L-spine