Low Back Pain Differential Diagnosis

The following is a differential diagnosis for low back pain, categorized for clarity and emphasis on critical conditions.

• Single Most Likely Diagnosis

  • Mechanical Low Back Pain: This is the most common cause of low back pain, often related to strain or overuse of the back muscles, or issues with the spinal discs, joints, or ligaments. Justification: High prevalence in the general population, especially in individuals with a history of heavy lifting, bending, or sudden awkward movements.

• 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. Justification: Common cause of back pain, especially with radiculopathy (pain, numbness, or weakness in the legs).
  • Degenerative Disc Disease: A condition where the spinal discs lose their cushioning ability, leading to pain and stiffness. Justification: Common in older adults due to wear and tear over time.
  • Spondylosis/Spondylolisthesis: Conditions involving defects in the pars interarticularis (a part of the vertebrae) that can lead to slippage of one vertebra over another. Justification: More common in younger individuals, especially those involved in sports that include repetitive hyperextension of the spine.

• Do Not Miss Diagnoses

  • 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. Justification: Requires immediate medical attention to prevent permanent neurological damage.
  • Spinal Infection (e.g., Discitis, Osteomyelitis): Infections of the spinal discs or vertebrae, which can be life-threatening if not treated promptly. Justification: Although less common, these conditions can have severe consequences, including paralysis or sepsis.
  • Spinal Tumor: Abnormal cell growth in or around the spine, which can compress nerves or the spinal cord. Justification: Early detection is crucial for effective treatment and preventing neurological deficits.
  • Abdominal Aortic Aneurysm: A condition where the aorta enlarges abnormally, which can cause back pain if it presses on the spine or leaks. Justification: A medical emergency that requires immediate intervention to prevent rupture and death.

• Rare Diagnoses

  • Spondyloarthritis (e.g., Ankylosing Spondylitis): A form of arthritis that primarily affects the spine, although other joints can also be involved. Justification: Less common than other causes of back pain but important to consider, especially in younger patients with chronic back pain and stiffness.
  • Osteoporotic Compression Fracture: A fracture of the vertebrae due to weakened bones, often seen in older adults or those with osteoporosis. Justification: While not the most common cause of back pain, it's an important consideration in at-risk populations due to its potential for significant morbidity.
  • Paget’s Disease of Bone: A chronic condition that can result in enlarged and misshapen bones, including those in the spine, leading to pain and neurological symptoms. Justification: Rare, but can have significant implications for bone health and requires specific management.