This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations.
A 41-year-old man reports the sudden onset of low back and left leg pain. The symptoms began while he was doing yard work and pulling out large bushes. Since the onset of the pain 2 days ago, it has worsened, although he took a single dose of ibuprofen when the pain began. The patient has no clinically significant medical history, and the physical examination is normal other than severe pain in the left leg with a straight-leg-raising maneuver to 40 degrees. He says, “I’m sure I slipped a disk,” and he requests magnetic resonance imaging (MRI) of the low back. What testing and treatment would you recommend?