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 Deficiency Neuropathy: Deficiencies in vitamins such as B12 or B6 can cause neuropathy, which may present with symptoms similar to those experienced by the patient.
- 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 potentially devastating condition that requires prompt diagnosis and treatment. The patient's symptoms of numbness, tingling, and loss of balance may be indicative of cauda equina syndrome.
- Spinal Cord Compression: The patient's symptoms of numbness, tingling, and loss of balance may be indicative of spinal cord compression, which can be caused by the moderate spinal canal stenosis at L3-L4 and L4-L5.
- Infection or Abscess: The patient's symptoms of pain and numbness may be indicative of an infection or abscess, which can cause neurological symptoms and requires prompt diagnosis and treatment.
- Rare diagnoses
- Amyloidosis: Amyloidosis is a rare condition that can cause neuropathy and may present with symptoms similar to those experienced by the patient.
- Sarcoidosis: Sarcoidosis is a rare condition that can cause neuropathy and may present with symptoms similar to those experienced by the patient.
- Lymphoma or Leukemia: Although rare, lymphoma or leukemia can cause neuropathy and may present with symptoms similar to those experienced by the patient.