06-09-2009, 12:06 PM
A 45-year-old male warehouse worker is evaluated for a back injury he experienced 4 months ago when lifting a heavy box; he has been bedridden intermittently since then. Today he is asking for a disability form to be completed so that he can be reassigned to a desk job. His back pain does not radiate and he has no lower-extremity weakness; however, he reports that both legs are completely numb. He takes over-the-counter NSAIDs but no prescription medications. He has no history of injection drug use and is otherwise healthy.
On physical examination, the temperature is normal, pulse rate is 74/min, and blood pressure is 126/82 mm Hg. The patient has exquisite diffuse lumbar and paraspinal tenderness to light palpation, with no areas of erythema or warmth; his spinal range of motion is decreased. Pressing downward on his head elicits lower back pain. Although he is able to passively extend his legs without pain when sitting down, he has back pain radiating down his right leg with a supine straight-leg-raising test. Lower-extremity motor strength is intact, and patellar and ankle reflexes are symmetric.
Which of the following is the most appropriate next step in the management of this patient's back pain?
A Cyclobenzaprine
B Psychologic evaluation
C Epidural corticosteroid injection
D Radiography of the lumbar spine
E MRI of the lumbar spine
On physical examination, the temperature is normal, pulse rate is 74/min, and blood pressure is 126/82 mm Hg. The patient has exquisite diffuse lumbar and paraspinal tenderness to light palpation, with no areas of erythema or warmth; his spinal range of motion is decreased. Pressing downward on his head elicits lower back pain. Although he is able to passively extend his legs without pain when sitting down, he has back pain radiating down his right leg with a supine straight-leg-raising test. Lower-extremity motor strength is intact, and patellar and ankle reflexes are symmetric.
Which of the following is the most appropriate next step in the management of this patient's back pain?
A Cyclobenzaprine
B Psychologic evaluation
C Epidural corticosteroid injection
D Radiography of the lumbar spine
E MRI of the lumbar spine