Back Pain Back Pain Diagnosis and Imaging 2 — Questions and Answers
Question 1: Which clinical finding differentiates a central disc herniation from a posterolateral herniation?
- Unilateral radiculopathy
- Bilateral leg symptoms and potential cauda equina signs (Correct answer)
- Localized back pain only
- Positive FABER test
Correct answer: Bilateral leg symptoms and potential cauda equina signs
Central herniations may compress multiple nerve roots and present with bilateral symptoms or cauda equina signs.
Question 2: Waddell's signs are used to identify which category of back pain presentation?
- Inflammatory back pain
- Non-organic or psychosocial factors (Correct answer)
- Neuropathic pain
- Fracture-related pain
Correct answer: Non-organic or psychosocial factors
Waddell's signs are physical exam findings that suggest psychosocial or non-organic contributors to back pain.
Question 3: On MRI, a Modic Type 1 change in vertebral endplates indicates which pathology?
- Fat replacement of bone marrow
- Bone marrow edema and inflammation (Correct answer)
- Sclerotic remodeling
- Normal aging changes
Correct answer: Bone marrow edema and inflammation
Modic Type 1 changes represent bone marrow edema and inflammation at the vertebral endplate, often associated with active discogenic pain.
Question 4: Which symptom pattern is most characteristic of lumbar spinal stenosis?
- Sharp constant back pain at rest
- Neurogenic claudication — leg pain relieved by sitting or flexing forward (Correct answer)
- Unilateral sciatica with coughing
- Night pain waking from sleep
Correct answer: Neurogenic claudication — leg pain relieved by sitting or flexing forward
Neurogenic claudication presents as bilateral leg pain/weakness with walking that is relieved by sitting or forward flexion.
Question 5: Which dermatome is affected by an L4 nerve root lesion?
- Lateral calf and dorsum of foot
- Medial lower leg and medial ankle (Correct answer)
- Posterior thigh and calf
- Lateral foot and small toe
Correct answer: Medial lower leg and medial ankle
The L4 dermatome covers the medial lower leg and medial ankle region.
Question 6: Which finding on history should raise suspicion for inflammatory back pain (e.g., ankylosing spondylitis) rather than mechanical back pain?
- Pain relieved with rest and worse with activity
- Morning stiffness lasting more than 1 hour and improvement with exercise (Correct answer)
- Acute onset after lifting
- Pain localized to one side only
Correct answer: Morning stiffness lasting more than 1 hour and improvement with exercise
Inflammatory back pain is characterized by morning stiffness >1 hour that improves with exercise and worsens with rest.
Back Pain Back Pain Diagnosis and Imaging 2
Which clinical finding differentiates a central disc herniation from a posterolateral herniation?