A healthy 75-year-old African-American man comes to the physician because of persistent lower back pain for the past six months. The pain disappears when he sits down, improves when he bends over his knees, and gets worse when he extends his back. A couple of times before, when he was walking, he had a sudden onset of intense pain radiating from his back to his thighs. His other medical problems include hypertension, gastroesophageal reflux disease and rheumatoid arthritis. He does not use tobacco, alcohol, or drugs. He lives in a house with his wife. His medications include aspirin, atenolol, lansoprazole, and naproxen. He has no known drug allergies. On physical examination, straight-leg raising to 90 degrees is negative. Hyperextension of the lumbar spine produces lumbar pain radiating to the gluteal region. His pedal pulses are palpable and full.
Which of the following is the most likely diagnosis?

Question

A healthy 75-year-old African-American man comes to the physician because of persistent lower back pain for the past six months.  The pain disappears when he sits down, improves when he bends over his knees, and gets worse when he extends his back.  A couple of times before, when he was walking, he had a sudden onset of intense pain radiating from his back to his thighs.  His other medical problems include hypertension, gastroesophageal reflux disease and rheumatoid arthritis.  He does not use tobacco, alcohol, or drugs.  He lives in a house with his wife.  His medications include aspirin, atenolol, lansoprazole, and naproxen.  He has no known drug allergies.  On physical examination, straight-leg raising to 90 degrees is negative.  Hyperextension of the lumbar spine produces lumbar pain radiating to the gluteal region.  His pedal pulses are palpable and full.
Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Explanation: Lumbar spinal stenosis is a degenerative disease that affects the elderly population. It is characterized by increased lumbar pain on extension of the spine. The pain usually improves when the patient sits down or when he bends forward (e.g., when using a grocery cart). (Choices A and C) Disappearance of the pain when the patient sits is highly specific for lumbar spinal stenosis. This characteristic pain is not found in spondyloarthrosis or vertebral fracture cases. (Choice B) Disc herniation pain worsens with lumbar flexion. (Choice E)Lumbago is usually self-limited, and the pain lasts for approximately two months. (Choice F)The preservation of pedal pulses helps distinguish the disease from vascular claudication. Educational objective: Lumbar spinal stenosis is frequently seen in elderly patients. It usually appears during the sixth decade of life, and is very unusual before that age. The associated pain characteristically disappears/decreases upon sitting down, increases with spine extension, and decreases with flexion. Therapy can be conservative or can include a lumbar epidural block. Surgical decompression through a laminectomy is an option when other therapies fail.

A Healthy 75-Year-Old African-American Man Comes to the Physician Because