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Download the article PDF: Clinical Image Challenges September 2026
A 79-year-old female presents to urgent care complaining of sharp, severe lower back pain for the past 2 months. The pain began when she was bending over to pick something up from the floor and has not improved. The pain occasionally radiates to her flank area but not down her legs, and she denies any bowel or bladder pattern changes. She tried acetaminophen, cold and warm compresses, and rest without any relief. The pain worsens when she sits for long periods of time with slight improvement with rest. Her main complaint is persistent difficulty with bending, lifting, reaching, walking downstairs, and cooking. Physical examination reveals normal vital signs and bony tenderness to her lumbar spine spinous processes, most notably to L1 – L2. Neurologic exam shows normal sensation and 4/5 strength to all extremities.
View the x-ray images taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.