Differential Diagnosis for 35 yo Male with Back Pain

• Single Most Likely Diagnosis
  • Lumbar Strain or Musculoskeletal Back Pain: This is the most likely diagnosis given the patient's history of back pain, worsening pain with walking, and initial relief with conservative management (Icy Hot, Tylenol, and hot packs). The patient's symptoms of worsening pain with activity and relief with rest and conservative measures are consistent with musculoskeletal back pain.
• Other Likely Diagnoses
  • Lumbar Disc Herniation: The patient's complaint of "sciatica" suggests possible nerve root irritation, which could be due to a herniated disc. This condition can cause back pain that worsens with walking and can radiate pain down the leg.
  • Degenerative Disc Disease: Given the patient's age and symptoms, degenerative disc disease is a possible cause of his back pain. This condition can lead to chronic back pain and worsen over time.
  • Spondylosis or Spondylolisthesis: These conditions involve defects in the pars interarticularis and can cause back pain, especially with activity. They could be considered given the patient's age and symptoms.
• Do Not Miss Diagnoses
  • Cauda Equina Syndrome: Although less likely, this is a serious condition that requires immediate medical attention. It involves compression of the cauda equina and can present with severe back pain, sciatica, and neurological deficits such as urinary retention or incontinence.
  • Spinal Infection (e.g., Discitis or Osteomyelitis): Infections of the spine can cause severe back pain and are more likely in patients with a history of recent infection or immunocompromised states.
  • Spinal Tumor: Tumors of the spine can cause back pain and neurological symptoms. Although rare, they are a critical diagnosis not to miss due to their potential impact on prognosis and treatment.
• Rare Diagnoses
  • Ankylosing Spondylitis: This is a chronic inflammatory disease that can cause back pain and stiffness, especially in younger males. However, it typically presents with morning stiffness and improves with activity.
  • Osteoporotic Compression Fracture: Although more common in older adults, osteoporotic compression fractures can occur in younger individuals, especially those with risk factors such as long-term steroid use or osteoporosis.