Differential Diagnosis for Alarm Back Pain Signals that Warrant ER Visit

Single Most Likely Diagnosis

• Musculoskeletal strain or sprain: This is often the most common cause of back pain and can be severe enough to prompt an ER visit, especially if the pain is acute and severe.

Other Likely Diagnoses

• Herniated disk: Can cause severe back pain, especially if it compresses a nerve root, leading to radiculopathy.
• Degenerative disc disease: Chronic condition that can cause severe back pain, especially if there is significant disc degeneration.
• Spondylolisthesis: A condition where a vertebra slips out of place, which can cause severe back pain and may require urgent attention.

Do Not Miss Diagnoses

• Cauda equina syndrome: A serious condition that occurs when the nerves in the spinal canal are compressed, leading to severe pain, numbness, and potentially permanent nerve damage if not treated promptly.
• Spinal infection (e.g., osteomyelitis, discitis): Infections of the spine can cause severe back pain and are medical emergencies due to the risk of serious complications, including paralysis and death.
• Spinal fracture: Especially in the context of trauma or osteoporosis, a spinal fracture can cause severe back pain and may require immediate medical attention to prevent further injury.
• Aortic dissection: Although less common, severe back pain can be a symptom of an aortic dissection, which is a life-threatening condition requiring immediate medical intervention.

Rare Diagnoses

• Spinal tumors: Both primary and metastatic tumors can cause back pain, although they are less common causes.
• Paget's disease of the bone: A chronic condition that can cause enlarged and misshapen bones, leading to back pain among other symptoms.
• Osteonecrosis of the spine: A rare condition where the bone tissue dies due to lack of blood supply, which can cause severe back pain.

Each of these diagnoses has the potential to cause significant morbidity or mortality if not promptly and properly addressed, highlighting the importance of a thorough evaluation for anyone presenting with alarm signs for back pain.