Nokea
A 33-year-old construction worker comes for evaluation and treatment of acute onset of low back pain. He notes that the pain is an aching located in the lumbosacral area. It has been present intermittently for several years; there is no known trauma or injury. He points to the left lower back. The pain does not radiate and there is no numbness or tingling in the legs or incontinence. He was moving furniture for a friend over the weekend. On physical examination, you note muscle spasm, with normal deep tendon reflexes and muscle strength. What is the most likely cause of this patient's low back pain?
Correct Answer: C
Rationale: The correct answer is C: Mechanical low back pain. This is the most likely cause as the patient's pain is aching, located in the lumbosacral region, intermittent for years, with no radiation, numbness, tingling, or incontinence. The physical exam findings of muscle spasm, normal reflexes, and muscle strength support this diagnosis. Mechanical low back pain is common and often related to muscle strain or overuse, as seen in this construction worker who was moving furniture.
Choice A (Herniated disc) is incorrect as the patient does not have radiation of pain or neurological symptoms. Choice B (Compression fracture) is unlikely without a history of trauma or injury. Choice D (Ankylosing spondylitis) is less likely given the lack of inflammatory symptoms and typical age of onset.