Differential Diagnosis for Tailbone Pain
Single Most Likely Diagnosis
- Coccydynia: This condition is characterized by pain in the tailbone area, which is consistent with the patient's symptoms. The anterior tilting of the coccyx visualized on the X-ray could be contributing to the pain.
Other Likely Diagnoses
- Sacroiliac Joint Dysfunction: Although the SI joints are reported as symmetrical and within normal limits, dysfunction in these joints can sometimes cause referred pain to the tailbone area.
- Lumbosacral Strain: Given the attempt at sacralization of the left transverse process of L5 with the upper left sacrum, there might be some degree of strain or instability in the lumbosacral region that could contribute to tailbone pain.
- Discogenic Pain: Even though disc spaces are maintained, discogenic pain from the lower lumbar discs could potentially radiate to the tailbone area.
Do Not Miss Diagnoses
- Cauda Equina Syndrome: Although the X-ray does not show any acute fracture or subluxation, cauda equina syndrome is a serious condition that requires immediate attention. It involves compression of the nerve roots in the lumbar spine and can cause severe pain, among other symptoms.
- Infection (e.g., Osteomyelitis, Discitis): Infections in the spine or sacrum can cause significant pain and need to be ruled out, especially if there are systemic symptoms such as fever or if the patient is immunocompromised.
- Tumor: Both benign and malignant tumors can cause pain in the tailbone area by compressing or invading nearby structures.
Rare Diagnoses
- Tarlov Cyst: These are rare, fluid-filled sacs that can form on the nerve roots in the sacrum, potentially causing pain in the tailbone area.
- Sacrooccygeal Teratoma: A rare tumor that develops at the base of the coccyx and can cause a variety of symptoms, including pain.
- Chordoma: A rare type of bone cancer that can occur in the spine, including the sacrum and coccyx, causing pain and other neurological symptoms.