You're The Flight Surgeon: Lumbar Stenosis

You are a retired Air Force flight surgeon who performs civilian pilot evaluations for the FAA as a Senior Aviation Medical Examiner (AME). A 56-yr-old airline transport pilot presents to your office for renewal of his first-class medical certificate. You are not his personal physician, but you previously evaluated him for renewal of his medical certificate 6 mo ago. You review his medical records and note that he has no significant past medical history and reported taking no medications. He currently holds a valid first-class medical certificate. At this time he reports that he has developed a gradual onset of progressive low back pain over the past several months. There is no history of trauma and no history of prior significant episodes of back pain. He was evaluated by his personal physician 1 mo ago. At that time he underwent X-rays of the spine and was prescribed ibuprofen. He obtained only partial relief of symptoms. Current symptoms are described as intermittent aching low back pain associated with walking and relieved with sitting. Associated pain and tingling involving both his legs is also reported. He denies weakness involving the legs and denies bowel or bladder dysfunction, fever, or weight loss. 1. Which of the following conditions are included in your initial differential diagnosis? A. Acute lumbar sprain. B. Lumbar spinal stenosis. C. Peripheral vascular disease. D. B and C. E. A, B, and C.