Differential Diagnosis for Back Pain

The following is a differential diagnosis for back pain, categorized for clarity and emphasis on potential severity.

• Single Most Likely Diagnosis

  • Musculoskeletal strain: This is the most common cause of back pain, often resulting from overuse, heavy lifting, or sudden awkward movements. The justification for this being the single most likely diagnosis is its high prevalence in the general population and the common presentation of back pain in clinical settings.

• Other Likely Diagnoses

  • Herniated disc: This condition occurs when the soft inner gel of the disc leaks out through a tear or crack in the outer layer, potentially irritating nearby nerves and causing pain. It's a common cause of back pain, especially in individuals with a history of heavy lifting or those who are overweight.
  • Degenerative disc disease: A condition where the spinal discs lose their cushioning ability, leading to pain and stiffness. It's more common in older adults due to the natural aging process.
  • Spondylosis: A defect in the pars interarticularis, the thin piece of bone that connects the superior and inferior articular facets of the spine. It can lead to spondylolisthesis, where a vertebra slips out of place.
  • Osteoarthritis: Wear and tear on the spinal joints can cause back pain, stiffness, and limited mobility. It's a common condition in older adults.

• Do Not Miss Diagnoses

  • Cauda equina syndrome: A serious condition that occurs when the nerves in the spinal canal are compressed, leading to loss of bladder and bowel control, among other symptoms. It requires immediate medical attention.
  • Spinal infection (e.g., osteomyelitis, discitis): Infections of the spine can cause severe back pain and are medical emergencies, especially if they lead to abscess formation or sepsis.
  • Spinal fracture: Especially in individuals with osteoporosis or those who have experienced trauma, a spinal fracture can cause sudden and severe back pain.
  • Cancer: Metastatic cancer to the spine or primary spinal tumors can cause back pain, and early detection is crucial for treatment and prognosis.

• Rare Diagnoses

  • Ankylosing spondylitis: A form of arthritis that primarily affects the spine, although it can also affect other joints. It leads to severe, chronic pain and discomfort.
  • Spinal stenosis: Narrowing of the spinal canal, which can put pressure on the spinal cord and nerves, causing pain, numbness, and weakness.
  • Paget's disease of bone: A condition that affects bone remodeling, leading to bones becoming weakened and deformed. It can cause back pain if the spine is involved.
  • Osteoporotic compression fracture: Although not rare in the elderly, it's less common in younger populations and can be overlooked, especially if the patient does not have a typical risk profile for osteoporosis.