Differential Diagnosis
The patient presents with symptoms of numbness, loss of balance, blisters between toes, neuropathy in feet, pain in feet at night, and tingling in feet up to knees, along with radiographic evidence of multilevel chronic degenerative spondylosis. The following differential diagnoses are considered:
- Single most likely diagnosis
- Lumbar Spondylosis with Radiculopathy: The patient's symptoms of numbness, tingling, and pain in the feet, along with the radiographic findings of multilevel disc space narrowing, diffuse disc bulge, and moderate spinal canal stenosis, are consistent with lumbar spondylosis with radiculopathy. The stable Grade 2 anterolisthesis of L4 on L5 with moderate spinal canal stenosis may be contributing to the patient's symptoms.
- Other Likely diagnoses
- Diabetic Neuropathy: The patient's symptoms of numbness, tingling, and pain in the feet are consistent with diabetic neuropathy. The presence of blisters between toes may indicate impaired sensation and increased risk of foot ulcers.
- Peripheral Artery Disease: The patient's symptoms of pain in the feet at night may be consistent with peripheral artery disease, which can cause intermittent claudication and rest pain.
- Vitamin B12 Deficiency: Vitamin B12 deficiency can cause neuropathy, numbness, and tingling in the feet, which may be contributing to the patient's symptoms.
- Do Not Miss
- Cauda Equina Syndrome: Although the radiographic findings do not indicate significant spinal canal stenosis at L5-S1, cauda equina syndrome is a medical emergency that requires prompt attention. The patient's symptoms of numbness, loss of balance, and bladder or bowel dysfunction (if present) may indicate cauda equina syndrome.
- Spinal Cord Compression: The patient's symptoms of numbness, tingling, and weakness in the legs may indicate spinal cord compression, which can be caused by the moderate spinal canal stenosis at L3-L4 and L4-L5.
- Rare diagnoses
- Amyloidosis: Amyloidosis can cause neuropathy, numbness, and tingling in the feet, although it is a rare condition.
- Lymphoma or Leukemia: Certain types of lymphoma or leukemia can cause neuropathy, numbness, and tingling in the feet, although these conditions are rare and would require further evaluation.
- Tarsal Tunnel Syndrome: Tarsal tunnel syndrome is a rare condition that can cause numbness, tingling, and pain in the feet, although it is less likely given the patient's radiographic findings and symptoms.