Differential Diagnosis for Back Pain

The following is a comprehensive differential diagnosis for back pain, categorized for clarity and emphasis on critical conditions.

• Single Most Likely Diagnosis
  • Musculoskeletal Strain: This is often the most common cause of back pain, resulting from overuse, heavy lifting, or sudden awkward movements. It affects the muscles and ligaments in the back.
• Other Likely Diagnoses
  • Herniated Disc: A condition where 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.
  • Degenerative Disc Disease: A condition where the spinal discs lose their cushioning ability due to wear and tear, leading to back pain.
  • Spondylosis: A defect in the pars interarticularis, the thin piece of bone that connects the superior and inferior articular facets of the spine, which can lead to back pain.
  • Osteoarthritis: Wear and tear of the spinal joints, leading to pain and stiffness in the back.
• 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. Immediate medical attention is required.
  • Spinal Infection (e.g., Osteomyelitis, Discitis): Infections of the spine that can cause severe back pain and require prompt antibiotic treatment.
  • Spinal Fracture: A break in one of the vertebrae, which can be caused by osteoporosis, trauma, or cancer, and requires immediate medical evaluation.
  • Cancer: Tumors in the spine, either primary or metastatic, can cause back pain and are critical to diagnose early.
• 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.
  • Spondylolisthesis: A condition where one of the vertebrae slips forward over the bone below it, which can cause back pain.
  • Paget’s Disease of Bone: A chronic condition that can result in enlarged and misshapen bones due to abnormal bone destruction and regrowth, potentially affecting the spine and causing back pain.

Each of these diagnoses has distinct characteristics and requires a thorough medical evaluation for accurate diagnosis and appropriate treatment. The categorization helps in prioritizing the most likely and critical conditions that should not be missed.