Differential Diagnosis for a 70-year-old Man with New Onset of Lower Back Pain with Sciatica and History of Prostate Cancer
- Single Most Likely Diagnosis
- Metastatic prostate cancer to the spine: This is the most likely diagnosis given the patient's history of prostate cancer. Prostate cancer commonly metastasizes to the bones, including the spine, which can cause lower back pain and sciatica.
- Other Likely Diagnoses
- Degenerative disc disease or lumbar spondylosis: Age-related wear and tear on the spine can cause lower back pain and sciatica, especially in a 70-year-old man.
- Lumbar spinal stenosis: Narrowing of the spinal canal can compress the nerves, leading to sciatica and lower back pain.
- Herniated lumbar disc: A herniated disc can compress the sciatic nerve, causing pain and discomfort.
- Do Not Miss Diagnoses
- Spinal cord compression or cauda equina syndrome: These are medical emergencies that require prompt attention. Compression of the spinal cord or cauda equina can cause severe and permanent damage if not treated promptly.
- Infection (e.g., osteomyelitis, discitis, or epidural abscess): Infections in the spine can cause severe pain and neurological deficits, and can be life-threatening if not treated promptly.
- Fracture (e.g., osteoporotic compression fracture): A fracture in the spine can cause severe pain and instability, and can be a sign of underlying osteoporosis.
- Rare Diagnoses
- Spinal tumor (primary or metastatic, other than prostate cancer): Although less likely, other types of spinal tumors can cause lower back pain and sciatica.
- Arachnoiditis: Inflammation of the arachnoid membrane surrounding the spinal cord can cause pain and neurological deficits.
- Epidural lipomatosis: Excess fat in the epidural space can compress the spinal cord or nerves, causing pain and discomfort.