To the Editor.
—In the Clinical Crossroads article entitled "A 50-Year-Old Woman With Disabling Spinal Stenosis,"1 the authors argue that Miss W has low back and leg pain due to spinal stenosis and that conservative treatment other than epidural injection of steroids has failed. Because epidural treatment is not covered by the patient's insurance, operative treatment is considered. Unfortunately, attributing the patient's symptoms primarily to spinal stenosis is unjustified. Given that significant conservative treatment options were neglected, the discussion of surgical options is premature.The patient, a 50-year-old overweight woman with a diagnosis of fibromyalgia, complains of intermittent low back pain and bilateral leg pain. Magnetic resonance imaging indicates spinal stenosis and mild lumbar disk disease. Her symptoms could be caused entirely or in part by spinal stenosis, midline lumbar disk disease, or fibromyalgia; because treatment of these entities differs, proper assessment of the role each plays is essential.
Levy CE, Clinchot DM, Bowyer BL, Pease WS. A 50-Year-Old Woman With Spinal Stenosis. JAMA. 1996;275(18):1400-1401. doi:10.1001/jama.1996.03530420028025