A 33-year-old Man With Low Back Pain

Abstract

A 33-year-old man was evaluated in the clinic for a 9-month history of low back pain. The pain was dull and low grade, worse with activity, occasionally waking him at night. He had no history of antecedent trauma. He had no radiation of pain, focal neurologic symptoms, balance difficulties, or difficulties with fine motor tasks. He had tried aspirin with variable relief, and acupuncture and chiropractic care with no significant improvement. He had no medical conditions, never had spine surgery, and never smoked. He exercised daily doing weight lifting and martial arts, with which his back pain interfered.On physical examination, the patient was generally healthy and appeared well. He had midline tenderness to palpation in his midlumbar spine. The patient had normal strength and ROM, and sensation was intact to light touch throughout. He had normal deep tendon reflexes and no long tract signs. He had normal gait and station.AP and lateral plain films (Fig. 1) of the lumbar spine were obtained initially, followed by CT (Fig. 2) and MRI (Fig. 3); the latter tests were ordered owing to the findings we observed on the plain radiographs.