Nevertheless, attempts to exclude serious pathology are the rationale for progressive and costly work up. Degenerative disc disease with resultant stress on supporting ligaments 2. Facet joint disease which may result from a degenerated disc or may be due to osteoarthritis of these joints. Clinical features of mechanical back pain include sudden onset, previous recurrent episodes, unilateral symptoms, and relief with rest. Examination reveals asymmetrical lumbar movements, asymmetrical straight leg raise, or radicular signs.
Spinal stenosis is an often overlooked cause of back and leg pain.
It is usually found in patients over age 60. Its caused by narrowing of the spinal canal or intervertebral foramen as a result of osteoarthritis. This contrasts with vascular claudication which improves on rest. Examination reveals stiff spine, normal straight leg raising, normal peripheral pulses and no radicular signs until late. CT is the study of choice.