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  • Degenerative conditions of the lumbar spine

  • Spinal osteoarthritis


  • 721 Spondylosis and allied disorders

  • 721.3 Lumbosacral spondylosis without myelopathy

  • 721.4 Thoracic or lumbar spondylosis with myelopathy

  • 721.42 Spondylosis with myelopathy, lumbar region

  • 721.9 Spondylosis of unspecified site

  • 721.90 Spondylosis of unspecified site, without myelopathy

  • 721.91 Spondylosis of unspecified site, with myelopathy


  • M47.16 Other spondylosis with myelopathy, lumbar region

  • M47.817 Spondylosis without myelopathy or radiculopathy, lumbosacral region

  • M47.819 Spondylosis without myelopathy or radiculopathy, site unspecified


  • 4B: Impaired Posture

  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Format Range of Motion Associated with Connective Tissue Dysfunction

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation


The patient is a 72-year-old woman with complaints of low back pain that has been increasingly getting worse over the last few years. Patient reports tingling and numbness down her right leg. She is fairly active and has been a walker and a golfer for many years. She has recently noticed that during walking there is a decrease in distance due to her right leg feeling heavy and tired. She has stopped playing golf due to decreased power in her swing and wonders if it is from the weakness in her leg.

She reports that she is very stiff in the morning and loosens up after she gets ready for the day. Patient reports that she has relief with Motrin. The patient says that she does not like driving and cannot sit through watching her television shows at night anymore. She says that the pain is not bad as long as she keeps moving, and standing always seems to help alleviate her pain. She said that she has to get her son to help her carry the groceries now because it hurts too much.

During the evaluation, there was hypomobility at L3/L4 and L4/L5 during passive intervertebral motion testing. She had a positive slump test and had a grade of +1 for right patella tendon reflex. She tested positive for straight leg raise test at 30 degrees.

Patient had imaging done and shows a narrowing of the spinal canal between L3–L4 and L4–L5.

FIGURE 132-1

Examination algorithm for the low back. (From Dutton M. Dutton’s Orthopaedic Examination, Evaluation, and Intervention. 3rd ed. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)



  • Osteoarthritis of the lumbar spine

  • Chronic degeneration

  • Progressive arthritis of the lumbar spinal joints

  • As the space between the lumbar vertebrae decreases, there can be compression onto the nerve roots

  • Arthritis can be central or lateral foramen based

    • Central: Usually bilateral symptoms ...

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