Module 39, General Orthopaedist Level

This 17 year old white female was involved in an MVA one week prior to presenting to the doctor's office. She presented with localized low back pain, there was no radiation of the pain. She had not noticed any weakness or numbness. At approximately 6 weeks post injury, she noted the onset pain with right leg radiation in an S1 distribution. She also experienced occasional paresthesias in the same area. Her Low Back Pain decreased at this point. She denied LE weakness or bowel/bladder dysfunction.

Question 39A

Her physical examination demonstrated decreased lumbar flexion which indicates that she probably has significant ligament damage.

Question 39B

Straight Leg Raise test was positive at 45 degrees which indicates that an MRI should be obtained to rule out disc herniation.

Question 39C

A negative contralateral Straight Leg Raise test is found and means that this could not be a herniated disc.

Question 39D

After 3 months of conservative treatment there was increased pain and a lumbar myleogram was obtained. Based on this further history and myleogram a lumber discectomy in indicated.

Question 39E

MRI is the best imaging study and is more specific to diagnosis all adolescent discs and similar lesions.

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