Case study: Mechanical lower back pain – Injection
A 45-year-old manual laborer presented with chronic lower back pain for a duration of 6 months. He has no comorbidities and conservative management with NSAIDs provides temporary relief. He reports occasional posterior thigh pain on the right side, without numbness or weakness.
Physical examination
- Paramedian lower back pain
- Unable to walk straight due to paraspinal muscle spasm
- Straight leg raise test: 70° of flexion was possible bilaterally
- Femoral stretch test: Negative
- FABER test: Negative
- Hip pathology was ruled out clinically
MRI findings
- Straightening of the lumbar spine
- Lower lumbar spondylosis
- Dehydrated discs at L3-L4, L4-L5, L5-S1
- Disc bulge with neural foraminal narrowing at L5-S1
- Normal sacroiliac joint
Note: Ultrasound has no diagnostic value in this case. It is used to guide specific interventions (e.g., lumbar facet joint injection).
Transducer and needle position for a lumbar facet joint injection.
Diagnosis
The patient was diagnosed with mechanical back pain. Lower back pain is commonly nonspecific or mechanical, originating from the spine, discs, or nearby tissues. Red flags like progressive motor/sensory loss, urinary issues, history of cancer, recent spinal procedures, and significant trauma necessitate further elevation or imaging. Imaging, reserved for suspected cases of cauda equina syndrome, malignancy, fracture, or infection, includes lumbar X-rays for fractures and MRI for neurological or soft tissue issues.
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