Differential Diagnosis for Acute Lower Back Pain and Radiculopathy with History of Lumbar Foraminal Stenosis
Single Most Likely Diagnosis
- Lumbar Radiculopathy: Given the patient's history of lumbar foraminal stenosis, the most likely cause of acute lower back pain and radiculopathy is exacerbation of the existing condition, leading to nerve root compression and inflammation.
Other Likely Diagnoses
- Lumbar Disc Herniation: A herniated disc can compress or irritate nearby nerves, causing pain and radiculopathy, and is a common condition in patients with pre-existing lumbar foraminal stenosis.
- Degenerative Spondylolisthesis: This condition, where one vertebra slips forward over the bone below it, can cause or exacerbate lumbar foraminal stenosis and lead to radiculopathy.
- Musculoskeletal Strain: Acute strain of the lower back muscles can cause significant pain and may radiate, mimicking radiculopathy, especially in the context of underlying structural issues like foraminal stenosis.
Do Not Miss Diagnoses
- Cauda Equina Syndrome: Although less common, this is a medical emergency where the nerves in the spinal canal are compressed, leading to severe neurological symptoms including loss of bladder and bowel control, and requires immediate surgical intervention.
- Spinal Infection (Abscess or Osteomyelitis): Infections of the spine can present with acute back pain and neurological deficits, and are critical to diagnose early due to their potential for serious complications.
- Spinal Tumor: Tumors, either primary or metastatic, can cause compression of the spinal cord or nerve roots, leading to pain and neurological symptoms, and their diagnosis significantly alters management and prognosis.
Rare Diagnoses
- Arachnoiditis: Inflammation of the membranes surrounding the spinal cord, which can cause severe pain and neurological symptoms, and is often associated with previous spinal surgery or infection.
- Epidural Lipomatosis: A rare condition where there is an abnormal accumulation of fat in the epidural space, which can compress the spinal cord or nerve roots and cause neurological symptoms.
- Tarlov Cysts: Abnormal fluid-filled sacs that can compress nerve roots, leading to pain and radiculopathy, though they are often asymptomatic and found incidentally.