CASE 12 Mr Barry Symonds is a 43 year old labourer who develops acute low back pain after lifting a heavy weight. The pain radiates down the back of his right leg. On examination he is unable to bend his back because of pain. His right ankle jerk is absent. 35. Which one of the following is the most appropriate first line investigation?

A) CT scan of the lumbar spine

B) Electromyography

C) Plain X-Ray of the lumbar spine

D) Ultrasound of the lumbar spine and course of sciatic nerve

Answer A 36. Pathology in which one of the following anatomical structures is likely to be the cause of his pain?

A) Cauda equina

B) Intervertebral disc

C) Ligamentum flavum

D) Zygapophysial joint

Answer B 37. Compression of which of the following nerve roots is likely to be causing Mr Symond’s neurological signs?

A) L2

B) L3

C) L4

D) L5

Answer D 83/02 Semester 1 Page 14 of 26

38. Which one of the following is the most appropriate first line treatment?

A) Epidural steroid injection

B) Normal activities and analgesics

C) Pain clinic referral

D) Urgent surgical decompression

Answer B **********************************************************************************