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March 10, 1999

Clinical Crossroads: A 45-Year-Old Man With Low Back Pain—Reply

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(10):893-895. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-10-jac90000

In Reply: The many letters in response to the Clinical Crossroads addressed 3 main issues: (1) electrodiagnostic testing, (2) physical therapy or chiropractic manipulation, or both, and (3) the use of colchicine.

Electrodiagnostic studies may have suggested altered nerve function, but would not be reliable in predicting Mr S's outcome. The issues of specificity and sensitivity must be considered to avoid overestimating or underestimating neural involvement. Mr S did not demonstrate any weakness on physical examination, his leg lengths were equal, and his range of motion was normal. There was no evidence of ongoing denervation. Regarding the pathomechanisms of leg pain, the article by Kawakami et al1 demonstrates a lack of correlation between axon histology and function. Further work is needed; however, these findings are noteworthy and should be thought about before embarking on a series of diagnostic tests in search of a treatment. The patient did not have a foot drop and there was no evidence of ongoing muscle dysfunction.