Differential Diagnosis for Back Pain

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

• 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, leading to pain and stiffness.
  • 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.
• 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 that can cause severe back pain and are potentially life-threatening if not treated promptly.
  • Spinal Fracture: Especially in patients with osteoporosis or those who have experienced trauma, a fracture can cause sudden and severe back pain.
  • Cancer: Metastatic cancer to the spine or primary spinal tumors 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.
  • Spinal Stenosis: Narrowing of the spinal canal, which can put pressure on the spinal cord and nerves, leading to pain and disability.
  • Paget's Disease of the Bone: A condition that affects bone remodeling, leading to bones becoming weakened and potentially causing back pain among other symptoms.

Each of these diagnoses has distinct characteristics and requires a thorough medical evaluation to determine the underlying cause of the back pain. The history, physical examination, and sometimes imaging studies or laboratory tests are crucial in making an accurate diagnosis.