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 and the common activities that can lead to it.
• Other Likely Diagnoses
  • Herniated disc: A condition where 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.
  • Degenerative disc disease: A condition where the spinal discs lose their cushioning ability, leading to pain and stiffness.
  • Spondylosis: A defect in the pars interarticularis, the thin piece of bone that connects the superior and inferior articular facets of the spine, which can lead to back pain.
  • Osteoarthritis: Wear and tear on the joints of the spine, leading to pain and stiffness. These diagnoses are considered likely due to their relatively high frequency in the population and their association with common risk factors such as age, physical activity level, and previous injuries.
• Do Not Miss Diagnoses
  • Spinal fracture: Especially in individuals with osteoporosis or those who have experienced significant trauma, a fracture can cause severe back pain and requires immediate medical attention.
  • Spinal infection (e.g., osteomyelitis, discitis): Infections of the spine can be serious and require prompt antibiotic treatment.
  • Cancer (metastatic or primary): Although less common, back pain can be a presenting symptom of spinal tumors, which necessitates early diagnosis and treatment.
  • Cauda equina syndrome: A serious condition where the nerves in the spinal canal are compressed, leading to loss of bladder and bowel control, among other symptoms. It is a medical emergency. These diagnoses, although potentially less common, are critical to identify due to their severe consequences if missed or delayed.
• Rare Diagnoses
  • Ankylosing spondylitis: A form of arthritis that primarily affects the spine, although it can also affect other joints.
  • Spinal stenosis: Narrowing of the spinal canal, which can put pressure on the spinal cord and nerves.
  • Paget's disease of bone: A condition that affects bone remodeling, leading to bones becoming weakened and deformed.
  • Osteonecrosis of the spine: Death of bone tissue due to lack of blood supply, which can lead to collapse of the vertebrae. These conditions are less common causes of back pain but should be considered, especially if initial treatments for more common conditions fail or if there are specific risk factors or symptoms present.