Lower Back And Right Leg Pain


Consult Page

72F w L4-5 stenosis with worsening lower back and leg pain

Initial Imaging

Fig. 34.1, A sagittal (A) and axial (B) T2 weighted lumbar MRI without contrast demonstrates multilevel spondylosis worst at L4-L5 with a central disc herniation causing moderate spinal canal stenosis and compression of traversing nerve roots.

Walking Thoughts

  • Where is the patient’s back and leg pain?

  • What is the patient’s neurological exam?

  • Is there any concern for cauda equina syndrome (e.g. saddle anesthesia, leg weakness, incontinence)?

  • What is the timeline of these symptoms? How stable or progressive have they been, and how do they compare to any previous back or leg pain?

  • Which symptom is worse: the back pain or the leg pain?

  • Does the leg pain follow a dermatomal distribution?

  • Does the patient have a history of spinal procedures?

  • What other medical comorbidities does the patient have?

  • Does the patient take any anticoagulant or antiplatelet medications?

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