Differential Diagnosis for Chronic Back Condition
The patient's symptoms and physical exam findings suggest a chronic back condition. Here's a differential diagnosis organized into categories:
- Single most likely diagnosis
- Spinal Stenosis: The patient's back pain is relieved with sitting and bending of the knees, which is a classic symptom of spinal stenosis. The wide-based gait and absence of tenderness over the gluteal region also support this diagnosis. The patient's age and history of hypertension, hyperlipidemia, and BPH increase the likelihood of spinal stenosis.
- Other Likely diagnoses
- Degenerative Disc Disease: The patient's chronic back pain and recent history of lying on his back working on his car may have exacerbated degenerative disc disease. However, the relief of pain with sitting and bending of the knees is more characteristic of spinal stenosis.
- Spondylosis: The patient's age and symptoms are consistent with spondylosis, but the lack of tenderness over the gluteal region and the negative straight leg test make it less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cauda Equina Syndrome: Although the patient's symptoms do not strongly suggest cauda equina syndrome, it is a medical emergency that requires prompt attention. The absence of urinary retention, fecal incontinence, or bilateral leg weakness makes it less likely, but it should not be entirely ruled out.
- Abdominal Aortic Aneurysm: The patient's history of hypertension and hyperlipidemia increases the risk of abdominal aortic aneurysm. However, the lack of abdominal pain, pulsatile mass, or other symptoms makes it less likely.
- Rare diagnoses
- Paget's Disease of the Bone: This rare condition can cause chronic back pain, but it is typically associated with other symptoms such as bone deformities, fractures, or elevated alkaline phosphatase levels.
- Osteoporotic Compression Fracture: Although the patient has risk factors for osteoporosis, such as hypertension and hyperlipidemia, the absence of recent trauma or vertebral body tenderness makes this diagnosis less likely.