Differential Diagnosis for Acute Lower Back Pain in a 59yo Female

Single Most Likely Diagnosis

• Musculoskeletal Strain: This is the most common cause of acute lower back pain, especially in individuals who may have lifted something heavy, bent, or twisted improperly. The sharp nature of the pain and radiation to the sides could be indicative of muscle or ligament strain.

Other Likely Diagnoses

• Lumbar Disc Herniation: The sharp pain and radiation to the sides could suggest nerve root irritation, which is often associated with a herniated disc. This condition is common in the lumbar region and can cause significant pain.
• Degenerative Disc Disease: As people age, the spinal discs can degenerate, leading to pain. The sharp nature of the pain could be due to the degeneration causing irritation of the surrounding nerves.
• Spondylosis: This condition involves a defect in the pars interarticularis, the thin piece of bone that connects the superior and inferior articular facets of the spine. It can cause lower back pain, especially if it leads to spondylolisthesis (slippage of a vertebra).

Do Not Miss Diagnoses

• Abdominal Aortic Aneurysm (AAA): Although less common, an AAA can present with lower back pain, especially if it is leaking or ruptured. This is a medical emergency that requires immediate attention.
• Kidney Stones: Severe, sharp pain that radiates to the sides could be indicative of a kidney stone, especially if accompanied by other symptoms like nausea, vomiting, or blood in the urine.
• Spinal Infection (e.g., Osteomyelitis, Discitis): Infections of the spine can cause severe back pain and are more common in older adults or those with compromised immune systems.
• Cauda Equina Syndrome: A serious condition that occurs when the nerves in the spinal canal are compressed, leading to loss of bladder and bowel control, among other symptoms. It requires urgent medical attention.

Rare Diagnoses

• Spinal Tumors: Both primary and metastatic tumors can cause back pain, although they are less common causes of acute lower back pain.
• Osteoporotic Compression Fracture: While more common in older adults with osteoporosis, these fractures can cause sudden, severe back pain.
• Paget's Disease of the Bone: A condition that can cause an abnormal breakdown and regrowth of bone tissue, leading to deformity and pain.