Differential Diagnosis for 41 yo Male with Numbness, Tingliness, and Neck Pain

• Single most likely diagnosis:
  • Cervical Spondylosis with Radiculopathy: The patient's symptoms of numbness, tingliness in the arms, and neck pain, combined with the X-ray findings of moderate disc space narrowing at C4-5 and C5-6, suggest cervical spondylosis with radiculopathy. The straightening of the cervical lordosis and early endplate osteophytic ridging further support this diagnosis.
• Other Likely diagnoses:
  • Cervical Disc Herniation: The patient's symptoms and the X-ray findings of disc space narrowing could also be consistent with a cervical disc herniation, which could be causing compression of the nerve roots leading to the symptoms.
  • Cervical Strain or Sprain: The patient's recent onset of neck pain and stiffness could be due to a cervical strain or sprain, although the X-ray findings suggest a more chronic process.
• Do Not Miss diagnoses:
  • Spinal Cord Compression or Injury: Although less likely, it is crucial to consider spinal cord compression or injury, as it can lead to serious and potentially permanent neurological deficits if not promptly addressed.
  • Infection (e.g., Osteomyelitis, Discitis): Infections of the spine can present with similar symptoms and must be considered, especially if there are systemic symptoms such as fever or if the patient is immunocompromised.
  • Tumor: Spinal tumors can cause neurological symptoms and must be ruled out, particularly if there is a history of cancer or if the symptoms are progressive and worsening.
• Rare diagnoses:
  • Multiple Sclerosis: Although rare, multiple sclerosis could present with numbness and tingliness, but it would typically be accompanied by other neurological symptoms and signs.
  • Amyotrophic Lateral Sclerosis (ALS): ALS is a rare condition that affects the nerve cells responsible for controlling voluntary muscle movement, and it could present with symptoms similar to those described, although it is much less likely.
  • Syringomyelia: A rare condition characterized by the formation of a fluid-filled cavity within the spinal cord, which could cause numbness, tingliness, and pain, but it is relatively rare and would likely require further imaging for diagnosis.