Differential Diagnosis for Lower Back Pain
The patient presents with a 2-year history of intermittent, dull, aching, paroxysmal pain in her lower back, which is exacerbated by excessive bending or unexpected exertion. Given the patient's age, symptoms, and lack of other systemic symptoms, the following differential diagnoses can be considered:
Single most likely diagnosis
- D) Multi-level degenerative disc disease: This is the most likely diagnosis given the patient's age, the nature of her pain (intermittent, exacerbated by bending or exertion), and the chronic duration of symptoms. Degenerative disc disease is a common cause of lower back pain in adults, especially after the age of 50.
Other Likely diagnoses
- B) Compression fracture: Although less likely without a history of trauma or osteoporosis, compression fractures can cause intermittent back pain, especially if the fracture is recent or if there are multiple fractures.
- A) Arachnoiditis: This condition, characterized by inflammation of the arachnoid membrane, can cause chronic back and leg pain. However, it is less common and often associated with a history of spinal surgery, infection, or trauma.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- C) Epidural enhancing mass lesion: Although rare, an epidural mass (such as a tumor or abscess) can cause back pain and neurological symptoms. It is crucial to consider this diagnosis to avoid missing a potentially life-threatening condition.
- E) Tethered cord: A tethered cord can cause back pain, especially with exertion, and is associated with spinal dysraphism. It is essential to consider this diagnosis, especially if there are any neurological symptoms or signs.
Rare diagnoses
- Other rare causes of lower back pain, such as spinal infections (e.g., osteomyelitis, discitis), inflammatory diseases (e.g., ankylosing spondylitis), or vascular diseases (e.g., aortic aneurysm), are less likely given the patient's presentation and lack of systemic symptoms. However, these conditions should be considered if the initial evaluation does not reveal a clear cause of the patient's symptoms.