What is the diagnosis for a patient with lumbar pain and radiculopathy, who has a history of chiropractic care, with worsening pain over the past few months, and an X-ray showing grade 1 scoliosis and anterolisthesis (anterior displacement of a vertebra) at L5-S1 with mild degenerative changes?

Differential Diagnosis for Lumbar Pain with Radiculopathy

Single Most Likely Diagnosis

• Lumbar Disc Herniation: Given the patient's history of worsening pain over the past few months, radiculopathy, and the presence of an anterolisthesis at L5-S1, a herniated disc is a highly plausible cause. The degenerative changes and scoliosis may contribute to the disc herniation.

Other Likely Diagnoses

• Degenerative Spondylolisthesis: The patient's anterolisthesis at L5-S1 with mild degenerative changes supports this diagnosis. Degenerative spondylolisthesis can cause lumbar pain and radiculopathy due to the slipping of the vertebra and subsequent nerve compression.
• Scoliosis with Degenerative Changes: Although the scoliosis is grade 1, it can still contribute to the patient's symptoms, especially when combined with degenerative changes. The altered spinal mechanics can lead to uneven wear and tear, causing pain and radiculopathy.
• Facet Joint Syndrome: The degenerative changes mentioned could involve the facet joints, leading to pain and radiculopathy. Facet joint syndrome is a common cause of lumbar pain, especially in patients with a history of degenerative changes.

Do Not Miss Diagnoses

• Cauda Equina Syndrome: Although less likely, cauda equina syndrome is a medical emergency that requires prompt diagnosis and treatment. It can present with radiculopathy, pain, and potentially bladder and bowel dysfunction. The presence of anterolisthesis and degenerative changes increases the risk.
• Spinal Infection (e.g., Discitis or Osteomyelitis): Infections of the spine can cause pain, radiculopathy, and degenerative changes. A history of chiropractic care could potentially introduce infection, although this is rare.
• Spinal Tumor: Tumors of the spine can cause pain, radiculopathy, and degenerative changes. Although rare, missing a spinal tumor could have severe consequences.

Rare Diagnoses

• Spondylolysis: A defect in the pars interarticularis, which could contribute to the anterolisthesis and symptoms. However, it's less likely given the patient's age and the presence of degenerative changes.
• Ehlers-Danlos Syndrome or Other Connective Tissue Disorders: These conditions can cause spinal instability and degenerative changes, leading to pain and radiculopathy. However, they are rare and would typically present with other systemic symptoms.