An 87-year-old woman is referred to you for evaluation of lower back pain. It is exacerbated by walking or prolonged standing and occa-sionally made better by bending over. Physical examination reveals a thin, elderly woman who walks with a cane with her lower back moderately flexed. Motor power in her lower extremities is normal, but she has impaired sensation to light touch and vibration below the L4 dermatome bilaterally. Deep tendon reflexes are normal in her upper extremities but absent in both lower extremities. You refer her for magnetic resonance imaging (MRI) of the lumbosacral spine. What will be the most likely finding on this study?
The clinical presentation indicates a lower motor neuron lesion. The clinical diagnosis is neurologic claudication secondary to lumbar spinal stenosis, which is commonly seen in eld-erly persons in whom (as a consequence of wear and tear over the years) bony structures of the lumbar spine hyperophy and develop osteophytes. These bony changes, in turn, lead to stenosis of the spinal canal and interveebral foramina. Thus, the result is compression and dysfunction of multiple lumbosacral nerve roots bilaterally. Bending over opens the lumbar canal and relieves the stenosis.
Lumbar spinal stenosis
A fracture of the odontoid process
A herniated L3-L4 disk causing unilateral compression of the L4 root
Spinal cord compression at the level of L1 veebra level
Cerebrovascular Diseases