Differential Diagnosis
- Single most likely diagnosis
- Herniated disc at L4-L5 with nerve root impingement: This is the most likely diagnosis given the MRI findings of a herniated disc at L4-L5 with contact between the disc and the L5 nerve root in the lateral recess bilaterally. The patient is likely to experience lower back pain, sciatica, and possibly numbness or weakness in the L5 dermatome.
- Other Likely diagnoses
- Degenerative disc disease: The MRI findings of desiccated intervertebral discs and minimal lumbar scoliosis suggest degenerative changes in the spine, which could contribute to the patient's symptoms.
- Spondylosis or spondylolisthesis: The sacralization of L5 and the presence of a herniated disc at L4-L5 could be related to underlying spondylosis or spondylolisthesis, which could cause mechanical low back pain and radiculopathy.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Spinal infection (e.g., discitis or osteomyelitis): Although the MRI findings do not specifically suggest an infection, it is essential to consider this possibility, especially if the patient has a fever, elevated white blood cell count, or other signs of infection.
- Spinal tumor: The small pseudonodular lesion at T12 could be a benign or malignant tumor, and it is crucial to further evaluate this finding to rule out a spinal tumor.
- Cauda equina syndrome: Although the MRI findings do not suggest a large disc herniation or other mass lesion causing cauda equina compression, it is essential to consider this possibility if the patient presents with severe low back pain, bilateral sciatica, or bowel/bladder dysfunction.
- Rare diagnoses
- Tarlov cyst: A rare condition characterized by the formation of cysts within the nerve roots, which could cause radiculopathy and low back pain.
- Arachnoiditis: A rare condition characterized by inflammation of the arachnoid membrane, which could cause chronic low back pain, radiculopathy, and other neurological symptoms.