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. This diagnosis is likely due to its prevalence in older adults and those with a history of smoking or obesity.
  • 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 cause back pain, especially in young athletes.
• 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 with spinal metastasis: Although less common, cancer that has spread to the spine can cause back pain and is a critical diagnosis not to miss due to its implications 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's characterized by chronic inflammation of the spine and the area where the tendons and ligaments attach to the bone.
  • Spinal epidural abscess: A rare but serious condition where an abscess forms outside the dura mater, which is the protective membrane surrounding the spinal cord. It can compress the spinal cord and cause neurological deficits.
  • Paget's disease of the bone: A chronic condition that can result in enlarged and misshapen bones due to abnormal bone destruction and regrowth. It can affect any bone but is more common in the spine, leading to back pain.