Sam Is a 25-Year-Old Who Has Been Diagnosed with Low

Sam is a 25-year-old who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination.As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion.Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?

A) Morning stiffness and limited mobility of the lumbar spine
B) Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain
C) Fever, chills, and elevated erythrocyte sedimentation rate
D) Pathologic fractures, severe night pain, weight loss, and fatigue