Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Prescribe NSAIDs and see the patient back in 2 weeks
14%
8/56
Perform a lumbar steroid injection
4%
2/56
Send the patient for an MRI of the lumbar spine
70%
39/56
Send the patient for a radiograph of the lumbar spine
11%
6/56
Refer the patient to physiatrist and see the patient back in 1 month
0%
0/56
Select Answer to see Preferred Response
The patient in this vignette most likely has lumbar spinal stenosis. The best test for this condition is an MR scan of the lumbar spine. Lumbar spinal stenosis classically presents with weakness, back pain and referred buttock pain, pain worsens with extension (walking downhill, standing upright) and is relieved with flexion at hips and bending forward (sitting, leaning over shopping cart). This condition can also present with bladder disturbances and recurrent UTI present in up to 10% due to autonomic sphincter dysfunction. On physical exam, a Kemp sign may be present (unilateral radicular pain from foraminal stenosis made worse by extension of back). Importantly, valsalva test does not worsen pain (pain is worse in the case of herniated disc). Last and Hulbert discuss the management of chronic low back pain. A history and physical examination can classify patients into distinct groups: nonspecific low back pain, back pain associated with radiculopathy or spinal stenosis, back pain referred from a non-spinal source or back pain associated with another specific spinal cause. For patients who have back pain associated with radiculopathy, spinal stenosis, or another specific spinal cause. If radicular pain is suspected, MR imaging or CT may establish the diagnosis. McGregor et al. performed a meta-analysis including 3 studies and 373 patients. They report that active rehabilitation following surgery for lumbar spinal stenosis is more effective than usual care in improving both short- and long-term (back-related) functional status. Short-term improvement in low back pain and long-term improvement in both low back pain and leg pain were observed, although limited impact was seen in relation to improvements in general health status, which were similarly improved with rehabilitation. Illustration A displays an MR image of lumbar spinal stenosis. Note the impingement of the spinal nerve roots. Incorrect Answers: Answer 1: NSAIDs are a valid treatment for lumbar spinal stenosis but only after a diagnosis has been confirmed. Answer 2: Steroid injections are a valid treatment for lumbar spinal stenosis but only after a diagnosis has been confirmed. Answer 4: X-rays are not the preferred imaging modality for this condition. Answer 5: Physical therapy is a valid treatment for lumbar spinal stenosis but only after a diagnosis has been confirmed.
5.0
(2)
Please Login to add comment