Differential Diagnosis for Spontaneous Lower Back Pain in a 91-year-old Patient
Single Most Likely Diagnosis
- Degenerative Disc Disease or Spondylosis: This is a common condition in the elderly, characterized by wear and tear on the spinal discs and joints, which can cause lower back pain without any specific incident or trauma. The age of the patient and the spontaneous onset of pain make this a highly plausible diagnosis.
Other Likely Diagnoses
- Muscle Strain: Although the patient reports no trauma, minor, unnoticed strains can occur, especially in the elderly, due to decreased muscle mass and strength.
- Osteoporotic Compression Fracture: Elderly individuals, especially those with osteoporosis, can experience vertebral compression fractures without significant trauma, leading to sudden onset of back pain.
- Spinal Stenosis: This condition, involving narrowing of the spinal canal, can cause lower back pain, especially when walking or standing, and is common in older adults.
Do Not Miss Diagnoses
- Cauda Equina Syndrome: A serious condition that requires immediate medical attention, characterized by compression of the nerves in the lower spine, which can cause severe back pain, leg weakness, and bladder or bowel dysfunction.
- Spinal Infection (e.g., Discitis or Osteomyelitis): Infections of the spine can present with back pain and are more common in older adults or those with compromised immune systems.
- Malignancy (Metastatic or Primary): Cancer can cause back pain, especially if it involves the spine, and although less common, it is critical not to miss this diagnosis due to its significant implications.
- Aortic Aneurysm or Dissection: Abdominal aortic aneurysms can cause lower back pain and are life-threatening if they rupture.
Rare Diagnoses
- Paget's Disease of the Bone: A condition that can cause an enlargement and deformity of bones, leading to back pain, though it is less common.
- Spondylolisthesis: A condition where one of the vertebrae slips forward over the bone below it, which can cause lower back pain and is less common in the elderly without a history of trauma or underlying condition.
- Epidural Lipomatosis: A rare condition where there is an abnormal accumulation of fat in the epidural space surrounding the spinal cord, which can cause back pain and neurological symptoms.