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 helpful in establishing the patient's 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 helpful in establishing the patient's diagnosis?

Quizplus · Accepted Answer

Explanation: The diagnosis of spinal stenosis in a patient with symptoms is best confirmed by using MRI of the spine. The encroaching of osteophytes at the facet joints, hypertrophy of the ligamentum flavum, and protrusion of intervertebral disks results in a narrowing of the spinal canal. In some patients, gait disturbance is so prominent that they complain of having "spaghetti legs" or walking "like a drunken sailor." The preservation of pedal pulses helps distinguish this disease from vascular claudication. (Choice A)X-ray will not be useful for the diagnosis of spinal stenosis. (Choice E)HLA-B27 is positive in more than 90% of patients with ankylosing spondylitis; however, the patient's history is not suggestive of this disease. Educational objective: MRI is the investigative procedure of choice for suspected lumbar spinal stenosis.

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