Differential Diagnosis for Lumbar Pain with Radiculopathy and History of 3 Spinal Surgeries

Single Most Likely Diagnosis

• Failed Back Surgery Syndrome (FBSS): This condition is characterized by persistent or recurrent back and leg pain after one or more spinal surgeries. Given the patient's history of three spinal surgeries, FBSS is a highly plausible diagnosis, as the likelihood of achieving complete pain relief decreases with each subsequent surgery.

Other Likely Diagnoses

• Herniated Disc: A herniated disc can cause radiculopathy and is a common reason for spinal surgery. Despite previous surgeries, a new herniation or recurrence at a different level could explain the patient's symptoms.
• Spinal Stenosis: This condition involves narrowing of the spinal canal, which can cause radiculopathy. It can be a progression of degenerative changes and might not have been fully addressed by previous surgeries or could have developed at a different spinal level.
• Spondylolisthesis: This condition, where one vertebra slips forward over the bone below it, can cause radiculopathy and back pain. It might have been a contributing factor to the need for previous surgeries and could still be causing symptoms if not adequately corrected.

Do Not Miss Diagnoses

• Spinal Infection (e.g., Osteomyelitis, Discitis): Infections of the spine can occur post-surgically and are critical to diagnose early to prevent serious complications. Symptoms can be non-specific and similar to those of other post-surgical complications.
• Cauda Equina Syndrome: This is a medical emergency characterized by low back pain, radiculopathy, and potentially bladder and bowel dysfunction. It requires immediate intervention to prevent permanent neurological damage.
• Epidural Abscess: Similar to spinal infections, an epidural abscess is a collection of pus that can compress the spinal cord or nerves, leading to severe neurological deficits if not promptly treated.

Rare Diagnoses

• Arachnoiditis: Inflammation of the arachnoid membrane surrounding the spinal cord, which can cause severe pain and neurological symptoms. It is a rare condition but can be a complication of spinal surgery.
• Spinal Tumor: Although rare, a spinal tumor could cause radiculopathy and back pain. The history of multiple surgeries might obscure the diagnosis, but it is essential to consider, especially if there are atypical features or rapid progression of symptoms.