Differential Diagnosis
- Single most likely diagnosis
- Lumbar Spondylosis: This diagnosis is the most likely due to the presence of endplate spurring, mild loss of disc height, and facet hypertrophic changes, which are all characteristic of degenerative changes associated with lumbar spondylosis. The patient's symptoms of bilateral sciatica also align with this diagnosis, as the degenerative changes can lead to nerve root compression.
- Other Likely diagnoses
- Lumbar Disc Degeneration: The mild loss of disc height at multiple levels (L2-3 through L4-5) suggests disc degeneration, which can contribute to the patient's sciatica symptoms.
- Facet Joint Syndrome: The prominent facet hypertrophic changes, especially at levels L3-4 through L5-S1, could be causing or contributing to the patient's sciatica symptoms due to inflammation or mechanical irritation of the facet joints.
- Lumbar Spinal Stenosis: Although not directly stated, the combination of facet hypertrophy and disc degeneration could potentially lead to spinal stenosis, especially if the changes are significant enough to narrow the spinal canal or intervertebral foramina, thus causing sciatica.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cauda Equina Syndrome: Although the vertebral body height and alignment are maintained, and there's no specific mention of severe neurological deficits, cauda equina syndrome is a medical emergency that requires prompt diagnosis and treatment. It could present with sciatica and should be considered, especially if there are symptoms such as bladder or bowel dysfunction.
- Spinal Infection (e.g., Discitis or Osteomyelitis): Infections of the spine can present with back pain and sciatica. While less likely given the description of chronic degenerative changes, an infection would be a critical diagnosis not to miss due to its potential for serious complications.
- Spinal Tumor: Tumors of the spine, whether primary or metastatic, can cause sciatica and should be considered, especially if there are atypical features or a history suggestive of malignancy.
- Rare diagnoses
- Ankylosing Spondylitis: This chronic inflammatory disease can cause back pain and sciatica, but it typically presents with more systemic symptoms and significant stiffness, and would be less likely given the description of maintained vertebral body height and alignment.
- Spondylolisthesis: Although not directly mentioned, if there were any degree of vertebral slippage, it could contribute to the patient's symptoms. However, the question stem mentions that vertebral body height and alignment are maintained, making this less likely.