Differential Diagnosis for 40-year-old with SLE and Recent ACDF
Single Most Likely Diagnosis
- Cervical spine instability or pseudarthrosis: Given the recent anterior cervical discectomy and fusion (ACDF) 2 months ago, the patient's symptoms of left lower extremity weakness and numbness could be indicative of instability or pseudarthrosis at the surgical site, which is a common complication following such procedures.
Other Likely Diagnoses
- Lupus flare: The patient's history of Systemic Lupus Erythematosus (SLE) makes a lupus flare a plausible explanation for the neurological symptoms, as SLE can affect multiple systems including the nervous system.
- Cervical radiculopathy: This condition, which involves nerve root irritation or damage, could explain the left lower extremity weakness and numbness, especially if the recent ACDF did not fully address the underlying issue or if there is a new disc herniation.
- Post-laminectomy syndrome (Failed Back Syndrome): Although the patient had an ACDF, similar principles apply, where the surgery might not have fully alleviated the pressure on the nerves, or there could be a new area of compression.
Do Not Miss Diagnoses
- Spinal epidural hematoma: A potentially life-threatening condition that could occur post-surgically, causing neurological deficits due to compression of the spinal cord.
- Infection (osteomyelitis, discitis, or epidural abscess): Post-surgical infections can present with non-specific symptoms including pain, fever, and neurological deficits, making them critical to rule out.
- Cervical spinal cord infarction: Although rare, a spinal cord infarct could present with acute onset of neurological deficits and is a medical emergency.
Rare Diagnoses
- Syringomyelia: A condition characterized by the formation of a fluid-filled cavity within the spinal cord, which could explain the progressive neurological symptoms.
- Multiple sclerosis: An autoimmune disease affecting the brain and spinal cord, which could present with a wide range of neurological symptoms, including weakness and numbness.
- Vasculitis involving the spinal cord: Given the patient's history of SLE, vasculitis affecting the spinal cord vessels is a rare but possible explanation for the symptoms.