Mechanical back pain Quiz: Ace Your Exams
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A 35-year-old woman presents to the primary care clinic with a 3-week history of severe low back pain radiating to her right leg. She describes the pain as a sharp, burning sensation that starts in her lower back and travels down the posterior aspect of her right thigh to her calf. The pain worsens with sitting, bending forward, and coughing. She denies any recent trauma but recalls lifting a heavy box three weeks ago, after which the pain started. She has had intermittent numbness and tingling in her right foot but has not had bowel or bladder incontinence. Vitals are within normal limits. On physical examination, the patient has an antalgic gait and prefers to stand rather than sit. There is minimal tenderness to palpation over the lower lumbar spine and paraspinal muscles. The straight leg raise test is positive on the right at 40 degrees, reproducing her leg pain. Motor examination reveals 4/5 strength in right foot dorsiflexion, and sensory examination shows decreased sensation over the dorsum of the right foot. Reflexes are diminished in the right Achilles tendon. Which of the following is most likely to be seen with diagnostic imaging?
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