Differential Diagnosis for Lumbar Spine CT Findings
Single Most Likely Diagnosis
- Lumbar Spondylosis with Multilevel Disc Bulges and Stenosis: This diagnosis is the most likely given the CT findings of diffuse disc bulges at multiple levels (L2-L3, L3-L4, L4-L5, and L5-S1) with associated canal and foraminal stenosis, which are characteristic of lumbar spondylosis. The presence of a calcified posterior margin at L5-S1 further supports this diagnosis.
Other Likely Diagnoses
- Degenerative Disc Disease: This condition is likely given the findings of disc bulges and loss of disc space height, although the latter is not explicitly mentioned, the presence of bulges suggests some degree of disc degeneration.
- Spinal Stenosis: The CT findings of moderate canal and foraminal stenosis at L4-L5 and L5-S1 levels support this diagnosis as a likely cause of the patient's symptoms.
- Foraminal Stenosis: Given the encroachment on neural foramina at multiple levels, foraminal stenosis is a likely diagnosis that could be contributing to the patient's symptoms.
Do Not Miss Diagnoses
- Cauda Equina Syndrome: Although less likely given the absence of specific findings like significant canal stenosis or a large disc herniation, cauda equina syndrome is a serious condition that requires prompt diagnosis and treatment. The presence of moderate stenosis at multiple levels necessitates consideration of this diagnosis.
- Spinal Infection (e.g., Discitis or Osteomyelitis): While the CT findings do not specifically suggest infection, the absence of intravenous contrast limits the ability to assess for inflammatory changes. Infection would be a critical diagnosis not to miss due to its significant implications for treatment and prognosis.
- Epidural Abscess: Similar to spinal infection, an epidural abscess is a potentially life-threatening condition that could present with non-specific findings on CT without contrast. It is essential to consider this diagnosis, especially if the patient has risk factors or symptoms suggestive of infection.
Rare Diagnoses
- Spinal Tumor (e.g., Neurofibroma, Meningioma): While rare, spinal tumors could present with similar findings of canal and foraminal stenosis. The absence of a mass lesion on the CT images makes this diagnosis less likely, but it should be considered, especially if the patient has a history suggestive of tumor or if symptoms persist or worsen despite conservative management.
- Arachnoiditis: This is a rare condition characterized by inflammation of the arachnoid membrane, which could potentially cause symptoms similar to those seen with lumbar spondylosis and stenosis. However, specific findings on CT or MRI, such as clumping of nerve roots, would be necessary to support this diagnosis.