Differential Diagnosis
The patient's symptoms and MRI findings suggest a condition affecting the lumbar spine. Here's a differential diagnosis organized into categories:
- Single most likely diagnosis
- Lumbar spinal stenosis: The patient's symptoms of pain radiating to the right buttock, exacerbated by standing or walking, and relieved by sitting or leaning forward are classic for lumbar spinal stenosis. The MRI findings of decreased visualization of the thecal sac and changes in the lumbar foraminal and lateral recesses also support this diagnosis.
- Other Likely diagnoses
- Lumbar disc herniation: A herniated disc can cause similar symptoms, especially if it's compressing a nerve root. The MRI findings could be consistent with a disc herniation, although the patient's symptoms are more suggestive of spinal stenosis.
- Lumbar spondylosis: This condition involves degenerative changes in the lumbar spine, which can cause similar symptoms. However, the patient's symptoms are more specific for spinal stenosis.
- Facet joint osteoarthritis: This condition can cause pain in the lower back and buttocks, but it's less likely to cause the specific symptoms and MRI findings described.
- Do Not Miss diagnoses
- Cauda equina syndrome: This is a rare but serious condition that requires urgent attention. Although the patient's symptoms don't suggest cauda equina syndrome, it's essential to consider this diagnosis to avoid missing a potentially devastating condition.
- Spinal infection (e.g., osteomyelitis, discitis): Infections can cause similar symptoms and MRI findings, and it's crucial to consider these diagnoses to avoid delayed treatment.
- Spinal tumor: Although rare, spinal tumors can cause similar symptoms and MRI findings. It's essential to consider this diagnosis to avoid missing a potentially life-threatening condition.
- Rare diagnoses
- Arachnoiditis: This is a rare condition characterized by inflammation of the arachnoid membrane, which can cause similar symptoms. However, it's less likely given the patient's specific symptoms and MRI findings.
- Tarlov cyst: This is a rare condition characterized by a cystic lesion in the spinal canal, which can cause similar symptoms. However, it's less likely given the patient's specific symptoms and MRI findings.