A 30-year-old female with a history of herniated disc presents with acute midline lumbar discomfort and radiating pain after lifting, unrelieved by Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Acetaminophen.

Differential Diagnosis

• Single most likely diagnosis
  • Lumbar strain:
    • This is the most likely diagnosis due to the patient's history of lifting a box at work, which is a common cause of lumbar strain. The patient's symptoms of midline lumbar discomfort, pain radiating up into her back, and muscle spasms are also consistent with this diagnosis.
• Other Likely diagnoses
  • Herniated disc (re-exacerbation):
    • The patient has a history of herniated disc, and the current symptoms could be a re-exacerbation of the previous condition. The patient's symptoms of midline lumbar discomfort and pain radiating up into her back are consistent with this diagnosis.
  • Musculoskeletal pain (e.g. muscle spasm, ligament sprain):
    • The patient's symptoms of muscle spasms and pain radiating up into her back could be due to musculoskeletal pain. This diagnosis is also likely due to the patient's history of lifting a box at work.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Spinal epidural abscess:
    • Although this diagnosis is unlikely, it is a medical emergency that requires prompt attention. The patient's symptoms of midline lumbar discomfort and pain radiating up into her back could be consistent with this diagnosis, especially if there is a history of fever or other systemic symptoms (although the patient denies fever).
  • Cauda equina syndrome:
    • This diagnosis is also unlikely, but it is a medical emergency that requires prompt attention. The patient denies symptoms such as urinary incontinence, bowel incontinence, or saddle anesthesia, which makes this diagnosis less likely.
• Rare diagnoses
  • Spinal tumor (e.g. metastatic cancer):
    • Although the patient denies a history of cancer, it is still possible that a spinal tumor could be the cause of her symptoms. This diagnosis is rare, but it is important to consider it in the differential diagnosis.
  • Inflammatory conditions (e.g. ankylosing spondylitis, rheumatoid arthritis):
    • These conditions are rare, but they could be the cause of the patient's symptoms. The patient's symptoms of midline lumbar discomfort and pain radiating up into her back could be consistent with these diagnoses.