Question

a 65 year old male patient presents with a complaint of sudden right sided low back pain that came on while loading the grocery bags in the car last night. he explains the pain as “sharp and shooting pain” that travels down the right leg. he grades the pain 7/10 on oswestry (low back pain questionnaire) which goes up to 9/10 when he coughs. as you observe his gait you notice a left antalgic lean. which of the following is the most likely diagnosis for this patient? a) lumbar sprain/strain b) posteromedial disc herniation c) right erector spinae muscle spasm d) posterolateral disc herniation

Explanation:

The patient has sudden - onset low - back pain radiating down the leg, which is a common symptom of disc herniation. The left antalgic lean is also a sign often associated with posterolateral disc herniation as the body tries to relieve pressure on the nerve root. Lumbar sprain/strain usually does not present with shooting pain down the leg. Posteromedial disc herniation is less likely to cause the described symptoms and gait change. Right erector spinae muscle spasm would not typically cause pain radiating down the leg in this pattern.

Answer:

d) Posterolateral disc herniation