Question

46-year-old man with a history of diabetes mellitus and chronic alcoholism presents to the Emergency Department with lower back pain that has progressively worsened over the last five days. He denies history of trauma. On examination, he has a temperature 37.9oC, heart rate 87 beats/minute, and blood pressure 146/75 mm Hg. He has tenderness with percussion over the midline lower lumbar spine. Achilles and patellar reflexes are intact. He has mild decreased sensation of both feet, but his strength is intact. What is the next best step in management?

a) Complete blood count
b) Magnetic resonance imaging of the lumbosacral spine
c) Pain control with ibuprofen and discharge home
d) Plain radiographs of the lumbosacral spine

Answer 1

The next best step is a Magnetic resonance imaging of the lumbosacral spine, as it helps diagnose potential serious conditions that might be causing the patient's back pain, such as spine infection or malignancy.

Step-by-step explanation:

The next best step in management for a 46-year-old man with a history of diabetes mellitus and chronic alcoholism, presenting with progressively worsening lower back pain, fever, and tenderness over the midline lower lumbar spine is b) Magnetic resonance imaging of the lumbosacral spine.

Given the clinical presentation and the lack of trauma history, this could suggest the possibility of a spine infection, like osteomyelitis or discitis, or other serious issues such as malignancy or vertebral fracture which are better visualized on MRI. While a complete blood count might provide supportive information, it is not as immediately helpful in the diagnosis and management of his back pain as an MRI; plain radiographs may not capture the early changes of infection or other details as effectively as MRI, and pain control alone without diagnosis could mask symptoms of a potentially serious condition.