Differential Diagnosis for Low Back Pain Radiating to Left Leg
Single Most Likely Diagnosis
- Lumbar Disc Herniation: The patient's symptoms of sharp pain in the left gluteal area and pain radiating to the left leg, along with pain and tingling in both legs when walking, are consistent with a lumbar disc herniation, particularly at the L4-L5 or L5-S1 level. This condition is a common cause of sciatica and radiculopathy.
Other Likely Diagnoses
- Lumbar Spondylosis: Degenerative changes in the lumbar spine can cause pain and stiffness, especially with activity, and may radiate to the legs due to foraminal stenosis.
- Piriformis Syndrome: The piriformis muscle can compress the sciatic nerve, causing pain, tingling, and numbness in the buttock and leg, which matches the patient's symptoms.
- Lumbar Spinal Stenosis: Narrowing of the lumbar spinal canal can cause pain, weakness, and numbness in the legs, especially with walking, due to compression of the spinal cord and nerve roots.
Do Not Miss Diagnoses
- Cauda Equina Syndrome: A serious condition where the nerves in the spinal canal are compressed, causing severe pain, numbness, and weakness in the legs, as well as bowel and bladder dysfunction. Although less likely, it is critical to rule out due to its potential for permanent damage if not promptly treated.
- Spinal Infection (e.g., Abscess or Osteomyelitis): Infections in the spine can cause severe back pain, fever, and neurological deficits. Early diagnosis and treatment are crucial to prevent serious complications.
- Spinal Tumor: Tumors in the spine can cause back pain, neurological deficits, and systemic symptoms like weight loss. Although rare, they must be considered to ensure timely intervention.
Rare Diagnoses
- Arachnoiditis: Inflammation of the arachnoid membrane surrounding the spinal cord, which can cause severe pain, numbness, and weakness in the legs.
- Tarlov Cyst: A rare condition where cysts form in the nerve roots of the spine, causing pain, numbness, and weakness in the legs.
- Lumbo-Sacral Neurinoma: A rare tumor of the nerve roots in the lumbar and sacral spine, which can cause back pain, sciatica, and neurological deficits.