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To the Editor: The Clinical Crossroads¹ about the 45-year-old attorney with low back pain was intriguing and brought out some of the diagnostic dilemmas in the practice of clinical medicine.

The patient consulted an orthopedic surgeon who recommended lumbar laminectomy with spinal fusion. The patient then obtained consultation with a neurosurgeon who advised against surgery and recommended that the patient should give up jogging. The discussant, Dr Weinstein, suggested that the patient should continue running and doubts that the patient will suffer any harm. Thus, the patient consulted 3 competent experts and received 3 different opinions regarding the management of his low back pain and numbness of his left foot.

Although the discussion by Weinstein was informative, there is an unexplained discrepancy. The patient complained of low back pain and numbness of his left calf and foot. Physical examination results were normal except for an absent ankle jerk on the . . . [Full Text of this Article]

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RELATED ARTICLE

A 45-Year-Old Man With Low Back Pain and a Numb Left Foot
James N. Weinstein
JAMA. 1998;280(8):730-736.
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