Differential Diagnosis for Worsening Leg Pain 2 Weeks Post Operative Discectomy

• Single Most Likely Diagnosis
  • Residual or recurrent disc herniation: This is a common cause of worsening leg pain after discectomy, as the herniated disc material may not have been completely removed or new herniation may occur at the same or adjacent level.
• Other Likely Diagnoses
  • Post-laminectomy syndrome (Failed Back Surgery Syndrome): This condition refers to chronic pain after spine surgery, which can be due to various factors including altered biomechanics, scar tissue, or inadequate decompression.
  • Infection (e.g., discitis, osteomyelitis): Postoperative infection can cause worsening pain, fever, and other systemic symptoms.
  • Epidural hematoma or abscess: Although less common, these conditions can cause severe pain, neurological deficits, and require urgent intervention.
• Do Not Miss Diagnoses
  • Cauda equina syndrome: A serious condition characterized by neurological symptoms such as bowel/bladder dysfunction, saddle anesthesia, and severe pain, requiring immediate medical attention.
  • Vertebral fracture or instability: Postoperative instability or fracture can lead to worsening pain and neurological symptoms.
  • Arterial or venous thromboembolism: Deep vein thrombosis or pulmonary embolism can occur after surgery, especially in patients with limited mobility.
• Rare Diagnoses
  • Spinal pseudomeningocele: A rare condition where a fluid collection forms in the spinal canal, causing pain, neurological symptoms, or mass effect.
  • Tarlov cyst: A rare type of cyst that can compress nerve roots, causing pain and neurological symptoms.
  • Spinal tumor: Although rare, a new or recurrent spinal tumor can cause worsening pain and neurological symptoms after discectomy.