Case presentation
The patient was a 49-year-old Saudi man who presented to the KKT Clinic at Qassim with severe low back pain radiating to both lower limbs. He walked into the clinic with an antalgic gait, an abnormal pattern of walking secondary to pain that ultimately causes a limp, and was holding walls while changing direction. His history showed that he developed back pain in 2016 and his back pain became more severe in 2018 when he weighed 130Kg. It affected his work to the point that he was off work for a year. In an attempt to relieve the back pain he underwent a gastrectomy in February 2020. Before the surgery his VAS was 6 or 7/10 and after the surgery it became 9/10. He lost 35 kg but the increase in back pain following the surgery caused him to stay in bed for a month. Post surgery he also developed a deficit in vitamin B12, folic acid, and iron. He took supplements and his vitamin and mineral values returned to normal. When he presented at the clinic he had low back pain radiating to both lower limbs, pain aggravated by standing, sitting, and walking, and he experienced stress, a sleep disorder, and frequent headaches, but had no history of other health disorders or accidents. Prior to presenting at the clinic he had used pain medications and standard treatments including physical therapy, osteopathy, and massage but none of these improved his pain or sleep. The patient has given informed written consent for his images and other clinical information to be reported in this journal.