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Old 01-22-2013
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Default back pain

A 75-year-old white man presents to his primary
care physician complaining of lower back
and leg pain. The pain is brought on by walking,
has been steadily worsening over the past
few years, and is not relieved by nonsteroidal
anti-infl ammatory drugs. In the past the pain
was confi ned only to his lower back and upper
leg/thigh, but in recent months it has started to
shoot past his knees. He states that the pain is
worst with walking, and he denies any recent
trauma or illness. On physical examination his
lower extremities are neurovascularly intact,
with full 5/5 strength, intact sensation, and 2+
dorsalis pedis and posterior tibial pulses.
Which is the most appropriate next step in diagnosis?
(A) CT of the spine
(B) Electromyography of the lower extremities
(C) Lumbar spine plain fi lms
(D) MRI of the lower back
(E) Whole body positron emission tomographic
scan
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  #2  
Old 01-22-2013
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(C) Lumbar spine plain fi lms
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Old 01-22-2013
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(C) Lumbar spine plain films= Degenerative Dz of spinal vertebra
(D) MRI of the lower back= Spinal stenosis

I will go with (C)= best initially, simple, quick, conclusive. If nothing next step MRI
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Old 01-23-2013
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The correct answer is D.

Lumbar spinal stenosis.

Patients with lumbar spinal stenosis present when the narrowed spinal canal and degenerative joint changes compress nerve roots and become symptomatic.The best diagnostic confirmation of this disorder is lumbar spine MRI, which may demonstrate bulging/protrusion of the intervertebral disks, osteophytes at the facet joints, or hypertrophy of the ligamentum fl avum. Because this patient experiences neurogenic claudication (ischemia of compressed nerves while walking),he would be a candidate for decompression surgery.

Answer C is incorrect. Plain films do not adequately image the soft tissues that may be involved with the etiology of lumbar spinal stenosis, including bulging/protrusion of the intervertebral disks, or hypertrophy of the ligamentum flavum.Plain films are useful in evaluating bony abnormalities such as OA.
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