A Man With Stooped Posture and Mysterious Back and Neck Pain

Nirupam Prakash, MD, MBBS


November 19, 2020

Physical Examination and Work-up

Upon physical examination, the patient is afebrile, with a pulse of 68 beats/min, a blood pressure of 138/82 mm Hg, and a normal respiratory rate. His weight is 159 lb (72 kg); height is 5 ft 3 in (63 in 160 cm); and body mass index (BMI) is 28.1 kg/m2. His waist circumference is 40 in (102 cm).

His cardiopulmonary and neurologic examination findings are normal. His abdomen is soft and without organomegaly. He is noted to have a forward stooping posture with loss of lumbar curvature of the spine. Detailed examination of the spine confirms an exaggerated dorsal spine curvature and loss of normal lumbar lordosis. Slight local tenderness is noted over the lumbar spine. Restriction of forward and lateral flexion of the spine is noted during the Schober test and finger-floor test on sideway bending. Neck movement is also restricted. No discernible spinal or paraspinal swelling is noted, and the peripheral and sacroiliac joints are not tender.

Laboratory tests include a hemoglobin level of 14 g/dL (reference range, 13.5-17.5 g/dL) and an erythrocyte sedimentation rate (ESR) of 12 mm/h (reference range, 0-30 mm/h). His fasting blood sugar level is 102 mg/dL (reference range, <100 mg/dL) and the postprandial level is 159 mg/dL (reference range for individuals with diabetes, <180 mg/dL). He has a glycated hemoglobin (A1c) level of 6.5% (6.5% or over indicates diabetes), urea level of 24 mg/dL (reference range, 7-20 mg/dL), creatinine level of 0.8 mg/dL (reference range, 0.84-1.21 mg/dL), and uric acid level of 4.1 mg/dL (reference range, 3.4-7 mg/dL). His serum calcium and phosphate measurements are 9.2 mg/dL (reference range, 8.5-10.5 mg/dL) and 3.9 mg/dL (reference range, 3.4-4.5 mg/dL), respectively. His alkaline phosphatase level is 44 IU/L (reference range, 44-147 IU/L), and his lipid profile shows a total cholesterol of 230 mg/dL (borderline high, 200-239 mg/dL), low-density lipoprotein (LDL) of 157 mg/dL (borderline high, 130-159 mg/dL), high-density lipoprotein (HDL) of 41 mg/dL (reference range, 40-59 mg/dL), and a triglycerides finding of 154 mg/dL (borderline high, 150-199 mg/dL). The thyroid-stimulating hormone is measured as 1.75 mIU/L (reference range, 0.4-4 mIU/L).

Lateral radiographs of the lumbosacral and cervical spine are shown (Figures 1 and 2). An anteroposterior pelvis radiograph is obtained (Figure 3).

Figure 1.

Figure 2.

Figure 3.


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