Differential Diagnosis for Lower Back Pain
Single Most Likely Diagnosis
- Musculoskeletal strain: Given the presence of slight lumbar levocurvature, which may be positional, and the absence of significant facet arthropathy or acute fracture, musculoskeletal strain is a plausible explanation for the patient's lower back pain. The fact that vertebral body heights are preserved and disc spaces appear grossly preserved also supports this diagnosis.
Other Likely Diagnoses
- Degenerative disc disease: Although the disc spaces appear grossly preserved, early degenerative changes might not be evident on X-ray. The patient's symptoms and the presence of a slight lumbar levocurvature could be indicative of early degenerative disc disease.
- Lumbar facet syndrome: The absence of significant facet arthropathy does not entirely rule out lumbar facet syndrome, as this condition can cause pain even in the absence of noticeable arthropathy on imaging.
- Sacroiliac joint dysfunction: Although the SI joints are described as patent and symmetric, dysfunction in these joints can still cause lower back pain and might not always be evident on X-ray.
Do Not Miss Diagnoses
- Cauda equina syndrome: This is a serious condition that requires immediate medical attention. Although the X-ray does not show any acute fractures or significant spinal abnormalities, cauda equina syndrome can occur due to other causes like disc herniation or spinal stenosis, which might not be visible on the provided X-ray.
- Spinal infection: Infections like osteomyelitis or discitis can cause lower back pain and might not be immediately apparent on X-ray. It's crucial to consider these diagnoses, especially if the patient has risk factors like immunocompromised status or recent travel/history of infection.
- Malignancy: Although rare, malignancies like metastatic disease to the spine can cause lower back pain. The absence of significant findings on the X-ray does not rule out this possibility entirely, especially if the patient has a history of cancer.
Rare Diagnoses
- Spondylolisthesis: This condition involves the slipping of one vertebral body over another and can cause lower back pain. However, it would typically be associated with more significant abnormalities on X-ray, such as a noticeable shift in vertebral body position.
- Spinal epidural abscess: This is a rare but serious condition that can cause lower back pain, fever, and neurological deficits. It might not be visible on X-ray and would require further imaging like MRI for diagnosis.
- Osteoporotic compression fracture: Although the X-ray reports vertebral body heights as preserved, osteoporotic compression fractures can sometimes be subtle and might not always be apparent on initial X-ray, especially if they are early or minor.