Differential Diagnosis for Low Back Pain
The patient's presentation of low back pain, particularly with a history of trauma, gradual worsening, and specific triggers, suggests several potential diagnoses. These can be categorized as follows:
Single Most Likely Diagnosis
- Lumbar Herniated Disc: The patient's symptoms of shock-like pain radiating down the legs, triggered by specific movements, and the history of trauma (tripping on a curb) support this diagnosis. The pain's description and radiation pattern, especially affecting one side and radiating down the leg, are classic for a herniated disc compressing a nerve root.
Other Likely Diagnoses
- Lumbar Strain: Given the patient's history of strenuous activities around the house and the onset of pain after a traumatic event, a lumbar strain is possible. However, the radiation of pain down the legs and the specific triggers might suggest a more structural issue like a herniated disc.
- Spondylosis or Spondylolisthesis: These conditions, which involve defects in the pars interarticularis or slippage of one vertebra over another, could explain the patient's pain, especially if they have a pre-existing condition that was exacerbated by the fall.
- Piriformis Syndrome: This condition, where the piriformis muscle compresses the sciatic nerve, could explain the buttock pain and radiation down the leg. However, it typically does not have such a clear traumatic onset.
Do Not Miss Diagnoses
- Cauda Equina Syndrome: Although the patient denies involuntary loss of bowel or bladder control, any suspicion of cauda equina syndrome (a condition where the nerves in the spinal canal are compressed) warrants immediate medical attention due to the risk of permanent neurological damage. The presence of severe, shock-like pain and radiation down the legs could potentially be part of this syndrome, especially if there are any "red flag" symptoms that are not immediately apparent.
- Spinal Infection or Abscess: Infections like osteomyelitis or discitis, or an abscess in the spinal canal, are rare but serious conditions that could present with severe back pain. A history of fever, recent travel, or immune compromise would increase suspicion.
- Spinal Fracture: Given the traumatic onset, a fracture should be considered, especially if the patient has risk factors for osteoporosis or was involved in a high-impact accident.
Rare Diagnoses
- Spinal Tumor: Tumors, either primary or metastatic, can cause back pain and neurological symptoms. They are less common but should be considered, especially with a history of cancer or unexplained weight loss.
- Arachnoiditis: Inflammation of the arachnoid membrane surrounding the spinal nerves can cause severe, burning pain and neurological symptoms. It's a rare condition but could be considered if other diagnoses are ruled out and the patient has a history of spinal surgery, infection, or contrast dye reactions.