Course 3, Case 10
Kas 3-10E: Low back pain irradiating into the lower extremity
Forty-one years old patient, working as manager of a textile company. He developed severe,
excruciating low back pain with irradiation into the right leg after lifting a heavy burden.
Family History: 65-years old mother with chronic low back pain, 67-years old father with
gonarthrosis, 44-years old healthy brother. His wife and 2 children are healthy.
Personal History: He has not suffered from any serious illness in the past, no trauma, no
surgery. No allergies. Non-smoker. No drugs.
Current Illness: He has been suffering from slight low back pain since 10 years. During this
weekend he worked in his garage, picked up a motorbike and immediately developed severe
low back pain with irradiation to the lateral part of his right thigh and calf. He noticed a
weakness of dorsiflexion of the right foot. His sphincter and sensory functions were normal.
Neurological status: A complete lumbar blockage with irradiation of pain to the external
aspect of the right lower extremity and into the big toe, paraspinal muscle spasms and slight
scoliosis to the left at Th-L level. Enfeebled dorsiflexion of the right foot, diminished
Achilles' tendon reflex on the right side, Laségue´s sign positive on the right side from 30
degrees, left 90 degrees, antalgic gait with impaired dorsiflexion of ankle and fingers on the
right side. Hardly able to move the fingertips from the floor.
Ouestions and tasks:
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Is it a nerve or a root impairment? Which one?
What is the most probable cause of this status?
What other investigations would you recommend?
What is a probable course of this disease?
Pathology: which pathological processes could cause a spinal cord compression?
Spinal cord lesions and cauda aequina syndrom