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Endgames Spot Diagnosis

A woman with lower back pain

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1117 (Published 16 March 2017) Cite this as: BMJ 2017;356:j1117

Rapid Response:

Re: A woman with lower back pain

How satisfying for Messrs Oputa and A’Court to have their clinical diagnosis of an L4/5 intervertebral disc displacement confirmed on an MRI scan! But what did they do with the result?

With the typical history of an acute onset of lumbar pain radiating to one leg with weakness of the muscles supplied by the L5 root, presumably also with limited straight-leg raising and possibly a sensory deficit in the L5 dermatome, the diagnosis is – or should be – obvious. (I take it that the findings were as explained in the discussion in the online version; the abbreviated history in the print version of ‘weakness in the leg’ implying the whole leg was weak is a different matter entirely.)

The treatment, we are informed, is ‘initial rest and analgesia followed by physiotherapy’ – in other words, doing nothing. But this is fine because, according to a citation from thirty years ago, ‘symptoms usually resolve within six weeks’. They should have gone back a little further for evidence of the superior effectiveness of epidural local anaesthesia in this situation (1).

symonds@tokyobritishclinic.com

(1) Coomes, EN. Comparison between epidural local anaesthesia and bed rest in sciatica. BMJ 7 Jan 1961, 20-24.

Competing interests: No competing interests

13 April 2017
Gabriel Symonds
General practitioner
Tokyo