Chronic low back pain Quiz: Ace Your Exams

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A 68-year-old man presents to the clinic for evaluation of six months of low back pain that radiates down the right leg. He describes the radiating pain as sharp, burning, and occasionally accompanied by tingling in the right foot. The pain worsens with prolonged sitting or lifting heavy objects, and he notices some relief when lying flat. He has not had fevers, weight loss, bowel or bladder dysfunction, or recent trauma. Vitals are within normal limits. Neurological exam reveals decreased sensation in the right lateral calf and dorsum of the foot as well as weakness with dorsiflexion of the right foot. Reflexes are normal in the upper extremities bilaterally and in the left lower extremity, but they are diminished at the right Achilles tendon. Bloodwork, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), is normal. Which of the following is most likely to be present?

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Pain in the bilateral buttocks

Family history of low back pain at an early age

Osteoporosis

Limited spinal mobility

Pain radiating down the right leg when the right leg is passively lifted while the knee is extended