We present the case of a 73-year-old man. His history of interest includes the absence of allergies to drugs. As cardiovascular risk factors, he had hypertension, diabetes mellitus, dyslipidemia and revascularized coronary artery disease with triple bypass. He had a pacemaker. He came to our department transferred by his general practitioner due to a 5-year history of mechanical low back pain, which, in the preceding 4 months had come to have a mixed rhythm that impeded him from sleeping at night. He was resistant to standard treatment with analgesics of the first and second steps of the World Health Organization pain ladder and nonsteroidal anti-inflammatory drugs.

In physical examination of his spine, we observed minimum scoliosis, negative pressure in the lumbar spine, limitation in flexion and extension in the final stages, with no other abnormalities, and a normal neurological examination. Plain radiology revealed lumbar scoliosis, minor listhesis of less than 20% of L5 over S1, with disk disease, vacuum phenomenon and posterior sclerosis suggestive of arthrosis. The abdominal aorta was calcified, with a considerable dilatation caused by an aneurysm measuring approximately 10cm in diameter (Fig. 1).

Fig. 1.

Anteroposterior and lateral radiographs of the lumbar spine. They show aneurysmatic dilation of the abdominal aorta labeled with a line that measures its transverse axis.

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Given this finding, the patient underwent vascular surgery within the next 48h, with disappearance of the mixed low back pain. Urgent laboratory tests had been performed prior to the operation. They showed a hemoglobin level of 10.3g/dL, with normal mean corpuscular volume and mean corpuscular hemoglobin; platelet levels and coagulation studies were normal. We found nothing abnormal in the liver function. Serum creatinine was 1.3mg/dL.

We performed computed tomography of the lumbosacral spine, that showed bilateral spondylolysis in L5 with grade 1 anterolisthesis of L5 on S1. The remaining vertebral bodies had conserved alignment, height and morphology. The diagnosis was L5-S1 interapophyseal osteoarthritis with degenerative disk disease. We observed interbody fusion, vacuum phenomenon and subchondral sclerosis in endplates. Small left posterolateral protrusion that was in contact with the thecal sac. The patient underwent aortoiliac repair secondary to treatment of abdominal aneurysm.

The abdominal aorta is the most common site of arterial aneurysms. Aneurysms can be asymptomatic. When symptoms are detected, the clinical approach depends on the site. Risk factors for rupture are tobacco use, hypertension, large size and presence of symptoms.1

The indication for surgical treatment in this patient was the large size of the aneurysm and the other risk factors, which implicated a high risk of rupture.2

As a conclusion, we should not overlook the causes of lumbar pain that is external to the spine. Low back pain can entail a severe underlying disease, and early treatment can improve the prognosis.

The authors declare they have no conflicts of interest.