A 63 year old female presents to your clinic with complaints of backache and a shooting pain along right lower leg.

 A 63 year old female presents to your clinic with complaints of backache and a shooting pain along right lower leg.

You decide to perform an X ray of LSS / Lumbosacral spine which is given below:

1. What are the findings in the X-ray?

2. What could be the likely cause of her right leg pain?

3. Which additional Investigations should be performed?

4.How would you manage this patient long term and what advise should be given to her with regards to change in lifestyle?

Answer given in comments section.

Copyright reserved with author. 

1. X- ray findings:

Reduced bone density of vertebrae.

Bony spurs at edges of vertebrae suggestive of Osteoporosis.

2. What could be the likely cause of her right leg pain?

Most likely Sciatica / irritation of sciatic nerve due to compression by osteoporotic vertebrae.

3. Which additional Investigations should be performed?

Additional Investigations:

DEXA scan

T scoring

Vitamin D levels

Alkaline phosphatase

MRI spine

Myeloma screen

Hb Electrophysiology

Urine Bence Jones proteins

4. Management:

Appropriate exposure to sunlight

Physiotherapy

Analgesic

Vitamin D supplements

Bone protection by Alendronate.

Healthy diet.