A 14-Year-Old Boy Is Brought to the Office Due to Lower

A 14-year-old boy is brought to the office due to lower back and buttock pain for 3 months.  The pain is diffuse across the lower back and buttocks, worsens with activity, and resolves with rest.  It occasionally radiates down the legs.  There is no history of trauma.  Vital signs are normal.  Examination shows a subcutaneous lipoma over the lower back, mild scoliosis, and weak ankle dorsiflexion.  Deep tendon reflexes are 1+ in the lower extremities and 2+ in the upper extremities.  The lower extremities are thin and weak.  What is the most likely diagnosis in this patient?

A) Ankylosing spondylitis
B) Becker muscular dystrophy
C) Guillain-Barré syndrome
D) Herniated disc
E) Tethered spinal cord

Correct Answer:

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