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 right 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 right antalgic lean is also more indicative of a posterolateral disc herniation as it causes nerve root irritation on one side. Lumbar sprain/strain and erector spinae muscle spasm usually do not present with shooting pain down the leg. Posteromedial disc herniation typically affects the central canal and may present differently.

Answer:

d) Posterolateral disc herniation