General: Overweight middle-aged man with stiff gait.
Examination of lumbar spine
Gait and movement—stiff, cautious. Posture—normal, no muscle spasm.
Tender over spinous process L4, over the L4-L5 interspinous space, and unilaterally to left between L4 and L5.
Restricted left lateral flexion and forward flexion ( Fig 11.1 ).
Lower limbs normal. No neurological abnormalities. Urine analysis: NAD
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