Differential Diagnosis
- Single most likely diagnosis
- Degenerative lumbar spine disease: This is the most likely diagnosis given the presence of multilevel degenerative changes, disc bulging, facet arthropathy, and spinal canal stenosis. The patient's symptoms and imaging findings are consistent with a chronic degenerative process.
- Other Likely diagnoses
- Spondylosis: The presence of grade 1 anterolisthesis of L4 on L5 and degenerative changes suggests spondylosis as a possible diagnosis.
- Lumbar spinal stenosis: The patient has mild spinal canal stenosis at L4-L5, which could be contributing to their symptoms.
- Facet joint syndrome: The presence of bilateral facet arthropathy and facet effusions at L4-L5 suggests facet joint syndrome as a possible diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Cauda equina syndrome: Although the patient does not have significant spinal canal stenosis, the presence of mild stenosis and neural foraminal narrowing could potentially lead to cauda equina syndrome if left untreated.
- Spinal infection: The presence of degenerative changes and facet effusions could potentially be masking a spinal infection, which would require prompt treatment.
- Malignancy: Although rare, malignancy could be a possible cause of the patient's symptoms and imaging findings, and should be considered in the differential diagnosis.
- Rare diagnoses
- Tarlov cyst syndrome: The presence of a small sacral meningeal/Tarlov cyst is noted, but it is unlikely to be the primary cause of the patient's symptoms.
- Renal parapelvic cysts: The presence of bilateral renal parapelvic cysts is noted, but it is unlikely to be related to the patient's spinal symptoms.
- Gallbladder disease: The presence of a gallstone and elongation of the gallbladder is noted, but it is unlikely to be related to the patient's spinal symptoms.