Differential Diagnosis for Left Lumbar Pain
The patient presents with left lumbar pain, a history of L4-5 herniated disc, and associated symptoms of sporadic tingling in her left leg. The following differential diagnoses are considered:
- Single most likely diagnosis
- Lumbar Disc Herniation: Given the patient's history of L4-5 herniated disc and current symptoms of left lumbar pain, sporadic tingling in her left leg, and radiation of pain up her back, a recurrent or new lumbar disc herniation is the most likely diagnosis. The lack of improvement with physical therapy and conservative management also supports this diagnosis.
- Other Likely diagnoses
- Lumbar Strain: The patient's recent episode of back spasm and lifting her dog on a plane could have caused a lumbar strain, which may be contributing to her current symptoms.
- Degenerative Disc Disease: The patient's age and history of L4-5 herniated disc increase her risk for degenerative disc disease, which could be causing her left lumbar pain and associated symptoms.
- Lumbar Facet Joint Pain: The patient's symptoms of left lumbar pain and radiation of pain up her back could be related to lumbar facet joint pain, which is a common cause of chronic low back pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cauda Equina Syndrome: Although the patient denies urinary frequency, urgency, or dysuria, cauda equina syndrome is a medical emergency that requires prompt diagnosis and treatment. The presence of sporadic tingling in her left leg and radiation of pain up her back warrants consideration of this diagnosis.
- Spinal Infection (e.g., Osteomyelitis, Discitis): The patient is afebrile and denies any recent illness, but spinal infection is a potentially life-threatening condition that requires prompt diagnosis and treatment.
- Spinal Tumor: Although rare, spinal tumors can cause back pain, tingling, and radiation of pain, and would be a devastating diagnosis if missed.
- Rare diagnoses
- Tarlov Cyst: A rare condition characterized by cysts forming on the nerve roots, which could cause back pain, tingling, and radiation of pain.
- Arachnoiditis: A rare condition characterized by inflammation of the arachnoid membrane, which could cause back pain, tingling, and radiation of pain.
- Spondylolisthesis: A rare condition characterized by slippage of one vertebra over another, which could cause back pain, tingling, and radiation of pain.