Differential Diagnosis

• Single most likely diagnosis
  • Spinal epidural abscess: This diagnosis is highly likely given the patient's recent history of spinal surgery (cervicothoracic decompression and fusion, and laminectomy for resection of epidural mass infection), progressive upper back pain, weakness, numbness ascending from the feet, and recent history of IV drug abuse. The patient's symptoms of pain, weakness, and numbness, along with the sudden onset of pain and pressure to the right eye (which has since resolved), are consistent with a spinal epidural abscess.
• Other Likely diagnoses
  • Spinal cord compression or injury: Given the patient's history of neurogenic bladder, recent spinal surgeries, and progressive neurological symptoms (weakness, numbness), spinal cord compression or injury is a plausible diagnosis.
  • Osteomyelitis or discitis: The patient's recent spinal surgeries and history of IV drug abuse increase the risk of osteomyelitis or discitis, which could explain the patient's back pain and neurological symptoms.
  • Metastatic spinal cord compression: Although less likely, given the patient's history of weight loss and recent onset of back pain, metastatic spinal cord compression should be considered, especially if a primary malignancy is identified.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Spinal hematoma: A spinal hematoma could occur as a complication of the recent spinal surgeries or anticoagulation (if the patient is on any), and would require urgent intervention to prevent permanent neurological damage.
  • Cauda equina syndrome: This condition, characterized by compression of the cauda equina, could explain the patient's progressive neurological symptoms (weakness, numbness, and bowel/bladder dysfunction) and requires prompt diagnosis and treatment to prevent permanent damage.
  • Meningitis: Although less likely, given the patient's recent surgeries and history of IV drug abuse, meningitis could be a life-threatening condition that requires urgent diagnosis and treatment.
• Rare diagnoses
  • Spinal arachnoiditis: This condition, characterized by inflammation of the arachnoid membrane, could explain the patient's back pain and neurological symptoms, but is less likely given the patient's recent surgeries and history of IV drug abuse.
  • Spondyloptosis: This rare condition, characterized by displacement of a vertebra, could explain the patient's back pain and neurological symptoms, but is less likely given the patient's recent surgeries and lack of trauma history.