Differential Diagnosis for a 93 Year Old Woman with Back Pain
Single Most Likely Diagnosis
- Osteoporotic Compression Fracture: Given the patient's age, osteoporosis is a common condition that can lead to vertebral compression fractures, which are a frequent cause of back pain in elderly women.
- Degenerative Disc Disease: Age-related wear and tear on the spinal discs can cause back pain, and this condition is highly prevalent in the elderly population.
Other Likely Diagnoses
- Musculoskeletal Strain: Back pain due to muscle or ligament strain is common and can occur at any age, including in the elderly, often due to minor trauma or overuse.
- Spondylosis: This condition, characterized by degenerative changes in the spine, can cause back pain and is more common with advancing age.
- Spinal Stenosis: Narrowing of the spinal canal can cause back pain, especially when walking or standing, and is more common in older adults.
Do Not Miss Diagnoses
- Cauda Equina Syndrome: A serious condition that requires immediate medical attention, characterized by nerve damage in the lower spine, which can cause severe back pain, numbness, and weakness in the legs.
- Spinal Infection (e.g., Osteomyelitis, Discitis): Infections of the spine can cause severe back pain and are more common in older adults or those with compromised immune systems.
- Malignancy (e.g., Metastatic Cancer): Cancer that has spread to the spine can cause back pain and is a critical diagnosis not to miss, especially in older adults with a history of cancer.
- Abdominal Aortic Aneurysm: Although less common, a ruptured or leaking abdominal aortic aneurysm can present with back pain and is a medical emergency.
Rare Diagnoses
- Paget's Disease of the Bone: A condition characterized by abnormal bone destruction and regrowth, which can cause back pain, although it is less common.
- Spinal Epidural Abscess: A rare but serious condition where an abscess forms outside the sac that contains the spinal fluid, which can cause back pain and neurological symptoms.
- Osteonecrosis of the Spine: A rare condition where the bone tissue in the spine dies due to lack of blood supply, which can cause back pain.