Differential Diagnosis
- Single most likely diagnosis
- Lumbar Disc Herniation (L5-S1): The patient's symptoms of neural pinch, loss of dorsiflexion, and pain improvement when not sitting are consistent with a lumbar disc herniation. The fact that bone movement accentuates pain and simple extension of the leg causes pain also supports this diagnosis.
- Other Likely diagnoses
- Lumbar Spondylosis: The patient's limited flexion of the lower back due to pain in the hip and posterior lower back could be indicative of lumbar spondylosis, which can cause similar symptoms to disc herniation.
- Piriformis Syndrome: The patient's symptoms of pain in the posterior lower back and leg, which improve when not sitting, could be consistent with piriformis syndrome, which can cause compression of the sciatic nerve.
- Facet Joint Syndrome: The patient's pain with extension of the leg and limited flexion of the lower back could be indicative of facet joint syndrome, which can cause pain and stiffness in the lower back.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cauda Equina Syndrome: Although less likely, cauda equina syndrome is a serious condition that requires immediate attention. The patient's symptoms of loss of dorsiflexion and pain with extension of the leg could be indicative of this condition, which can cause permanent nerve damage if left untreated.
- Spinal Infection (e.g. osteomyelitis, discitis): Infection of the spine can cause similar symptoms to disc herniation and spondylosis, and can be life-threatening if left untreated.
- Spinal Tumor: A spinal tumor can cause similar symptoms to disc herniation and spondylosis, and can be life-threatening if left untreated.
- Rare diagnoses
- Tarlov Cyst: A rare condition where a cyst forms on the nerve root, which can cause similar symptoms to disc herniation and spondylosis.
- Arachnoiditis: A rare condition where the membranes surrounding the spinal cord become inflamed, which can cause similar symptoms to disc herniation and spondylosis.
- Neuropathic Arthropathy (e.g. Charcot spine): A rare condition where the spine becomes unstable due to nerve damage, which can cause similar symptoms to disc herniation and spondylosis.