Differential Diagnosis for Lumbar XR with Right Leg Weakness
Single Most Likely Diagnosis
- Lumbar Spondylosis with Radiculopathy: The presence of disc space narrowing, spurring, and facet joint sclerosis and hypertrophy at L3-4, L4-5, and L5-S1 levels, along with right leg weakness, suggests lumbar spondylosis as the most likely cause. These changes can lead to nerve root compression, resulting in radiculopathy and symptoms like leg weakness.
Other Likely Diagnoses
- Lumbar Spinal Stenosis: Although the spinal canal is reported as normal, the presence of facet joint hypertrophy and sclerosis, especially at L4-5 and L5-S1, could contribute to lateral recess stenosis or foraminal stenosis, leading to nerve root compression and symptoms.
- Degenerative Disc Disease: The disc space narrowing and spurring at multiple levels indicate degenerative disc disease, which can cause or contribute to the patient's symptoms, including right leg weakness, due to disc herniation or instability.
Do Not Miss Diagnoses
- Cauda Equina Syndrome: Although less likely given the normal spinal canal and absence of specific mention of cauda equina syndrome symptoms (e.g., bilateral leg weakness, bladder/bowel dysfunction), it is crucial to consider this diagnosis due to its potential for severe and irreversible neurological damage if not promptly addressed.
- Spinal Infection or Osteomyelitis: Infection could present with similar radiographic findings, especially if there's disc space narrowing and endplate changes. The presence of vascular calcifications might suggest atherosclerotic disease but does not directly relate to spinal infection; however, considering the patient's age and symptoms, infection should be ruled out.
- Metastatic Disease: Given the patient's age, metastatic disease to the spine could present with vertebral body or disc changes, although the radiograph does not specifically suggest this. It's essential to consider this diagnosis due to its significant implications for treatment and prognosis.
Rare Diagnoses
- Paget's Disease of Bone: This condition can affect the spine and cause neurological symptoms due to vertebral body enlargement or softening, but the radiographic findings provided do not specifically suggest Paget's disease.
- Spondylolisthesis: Although not mentioned, spondylolisthesis (especially degenerative) could be a consideration with the given findings, particularly if there were any mention of vertebral body misalignment or slippage, which could contribute to spinal stenosis or nerve root compression.