Rheumatology: 3. Getting the most out of radiology

The caseA 72-year-old man has been seeing the same physician for 2 decades, and his only complaint has been intermittent mild low-back pain over the last 8-10 years. The pain had not interfered with his enjoyment of an active life, which included golf, tennis and gardening. However, over the past year the low-back pain has increased and is particularly noticeable when the man is walking. The pain radiates to his right thigh and calf. It is not aggravated by Valsalva9s manoeuvre and is relieved within 2 minutes by sitting. The man has had to give up most of his activities and can walk only 2 blocks. Over-the-counter analgesics and anti-inflammatory drugs, chiropractic, physiotherapy and massage have not provided lasting relief. His physician notices that he walks with a slightly stooped posture. The examination, including a detailed neurologic assessment, is normal except for tenderness over the L5-S1 vertebrae and quite marked restriction of lumbar spine movements.