Differential Diagnosis for Lower Back Pain in a 72-year-old Woman
Single Most Likely Diagnosis
- Lumbar Spinal Stenosis: This condition is characterized by the narrowing of the spinal canal, which can cause pain, numbness, and weakness in the lower back and legs. The patient's symptoms, such as pain radiating to the buttocks and relief when sitting or leaning forward, are consistent with lumbar spinal stenosis. The MRI findings of decreased visualization of the thecal sac and changes to the lumbar foramen and lateral recesses also support this diagnosis.
Other Likely Diagnoses
- Degenerative Disc Disease: This condition can cause chronic back pain, especially in older adults. The patient's history of chronic back pain and recent worsening of symptoms after physical activity (gardening) could be related to degenerative disc disease.
- Spondylosis: This condition refers to the degeneration of the spinal joints and discs, which can cause pain and stiffness in the lower back. The patient's age and symptoms are consistent with spondylosis.
- Facet Joint Syndrome: This condition occurs when the facet joints in the spine become inflamed or irritated, causing pain and stiffness. The patient's pain radiating to the buttocks and relief when sitting or leaning forward could be related to facet joint syndrome.
Do Not Miss Diagnoses
- Cauda Equina Syndrome: This is a serious condition that occurs when the nerves in the spinal canal are compressed, causing pain, numbness, and weakness in the lower back and legs. Although the patient does not have any "red flag" symptoms such as urinary retention or fecal incontinence, cauda equina syndrome is a potentially deadly condition that should not be missed.
- Spinal Fracture: Although the patient has no history of recent acute traumatic injury, a spinal fracture could still be present, especially in an older adult with osteoporosis. A fracture could cause chronic back pain and worsening of symptoms with activity.
- Infection (e.g., Discitis or Osteomyelitis): Infections of the spine can cause chronic back pain, fever, and other systemic symptoms. Although the patient does not have any obvious signs of infection, this diagnosis should not be missed due to its potential severity.
Rare Diagnoses
- Spinal Tumor: Although rare, spinal tumors can cause chronic back pain, numbness, and weakness in the lower back and legs. The patient's age and symptoms could be consistent with a spinal tumor, but this diagnosis is less likely without other supporting evidence.
- Arachnoiditis: This is a rare condition characterized by inflammation of the arachnoid membrane surrounding the spinal cord, causing chronic back pain, numbness, and weakness. Although the patient's symptoms could be consistent with arachnoiditis, this diagnosis is less likely without other supporting evidence.