Differential Diagnosis

Given the patient's symptoms and history, the following differential diagnoses can be considered:

• Single Most Likely Diagnosis
  • Chronic Low Back Pain: This is the most likely diagnosis given the duration of symptoms (six months) and the lack of success with conservative management. Chronic low back pain can significantly affect quality of life and cause movement limitations.
• Other Likely Diagnoses
  • Degenerative Disc Disease: A common condition in individuals over 40, it can cause chronic back pain and movement limitations due to the degeneration of spinal discs.
  • Spondylosis: A condition characterized by the degeneration of the spinal joints, which can lead to chronic pain and stiffness.
  • Spinal Stenosis: Narrowing of the spinal canal, which can cause pain, numbness, and movement limitations, especially in older adults.
• Do Not Miss Diagnoses
  • Spinal Tumors: Although rare, spinal tumors can cause chronic back pain and neurological symptoms. Missing this diagnosis could be deadly.
  • Infections (e.g., Osteomyelitis, Discitis): Infections of the spine can present with chronic back pain and are critical to diagnose early to prevent serious complications.
  • Cauda Equina Syndrome: A serious condition that requires immediate medical attention, characterized by numbness, weakness, and pain in the lower back and legs, along with bladder and bowel dysfunction.
• Rare Diagnoses
  • Ankylosing Spondylitis: A form of arthritis that primarily affects the spine, although it can occur at any age, it's less common in individuals without a prior history of back problems.
  • Paget's Disease of the Bone: A condition that can cause bones to become enlarged and deformed, leading to chronic pain and movement issues, though it's more commonly associated with other skeletal issues.