Back pain Quiz: Ace Your Exams

A 32-year-old woman G1P1 comes to the clinic due to insidious onset of back pain over the past few weeks. She did not seek care because she thought it would pass by itself. A month ago, she gave birth to a healthy boy at 37 weeks of gestation. She received epidural anesthesia. After birth, she started having back pain and has had difficulty performing chores around the house and taking care of the baby. During the past 2 weeks, the back pain increased in severity, and she started having fevers. She has no bowel or bladder symptoms. The patient’s temperature is 37.7°C (99.8°F), pulse is 90/min, and blood pressure is 135/85 mmHg. On physical examination, she appears uncomfortable and has difficulty ambulating. Motor strength is 5/5, and sensation is intact on both lower extremities. Patellar and Achilles reflexes are 2+ bilaterally. There is focal tenderness and muscle spasm at the L1-L2 levels. Laboratory results show a WBC count of 10,000/mm³ (reference range: 4,500-11,000/mm³) and an erythrocyte sedimentation rate of 100mm/hr (reference range: 0-20 mm/hr). Which of the following is the most appropriate step in the management of this patient?