A 70 year old man comes to the physician complaining about back pain that he has had for the past 8 months. He states that the back pain is located in the lower region. He states that he has an intermittent dull pain that becomes better when he bends forward and gets worse when he extends back. His medical history includes hypertension, hyperlipidemia, and diabetes mellitus. His medications include aspirin, losartan, metformin and atorvastatin. On physical exam, his pedal pulses are full and palpable. The straight leg test is negative.
What is his likely diagnosis?
A) disc herniation
B) Lumbar spinal stenosis
C) Osteoarthritis
D) Vertebral Fracture
E) Rheumatoid Arthritis
B) Lumbar spinal stenosis
It is a degenerative disease seen in elderly population. It is characterized by increased back pain on extension of the spine and it improves when the patient sits down or bends forward. Lumbar spinal stenosis is a narrowing of the spinal canal, compressing the nerves traveling through the lower back into the legs. While it may affect younger patients, due to developmental causes, it is more often a degenerative condition that affects people who are typically age 60 and older. Narrowing of the spinal canal usually occurs slowly, over many years or decades. The disks become less spongy with aging, resulting in loss of disk height, and may cause bulging of the hardened disk into the spinal canal. Bone spurs may also occur and ligaments may thicken. All of these can contribute to narrowing of the central canal and may or may not produce symptoms. Symptoms may be due to inflammation, compression of the nerve(s) or both. Symptoms include:
Pain, weakness or numbness in the legs, calves or buttocks
Cramping in the calves with walking, requiring frequent short rests to walk a distance
Pain radiating into one or both thighs and legs, similar to the lay term “sciatica”
In rare cases, loss of motor functioning of the legs, loss of normal bowel or bladder function
Pain may improve with bending forward, sitting or lying down
