Ortho Hors D'oeuvres (Prompt):

Patient is a 56 year-old healthy female presenting with back pain. Four days prior to presentation, the patient was leaning over her bed to pick up a yoga mat when she felt a "pop" in her lower back with subsequent severe pain. She saw her primary care provider who diagnosed her with a musculoskeletal strain and prescribed baclofen. She is now presenting to the emergency department for further pain control. She denies numbness, weakness, or bowel or bladder incontinence. On physical examination, she has no midline tenderness, and has full strength in bilateral lower extremities.

Radiographs are below:

Questions:

1) What history and/or physical exam findings would warrant x-ray imaging in this patient? 2) What is the injury shown on the above radiographs? 3) What are the next steps in diagnosis and management?


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