Differential Diagnosis for Lower Back Pain
Single Most Likely Diagnosis
- Lumbar Spondylosis: This is a common condition characterized by the wear and tear of the lumbar spine, leading to chronic lower back pain, often radiating to the outer sides. The chronic nature and location of the pain make this a highly plausible diagnosis.
Other Likely Diagnoses
- Lumbar Strain: Muscle strain in the lower back can cause pain on the outer sides, especially if the strain affects the muscles that run along the spine or the lateral aspects of the back.
- Lumbar Disc Herniation: Although more commonly associated with radicular pain, a herniated disc can cause chronic lower back pain that may be more pronounced on one side or the other, depending on the location and size of the herniation.
- Trochanteric Bursitis: Inflammation of the bursa over the trochanter (the bony prominence on the outer aspect of the hip) can cause pain in the outer side of the lower back and hip area, which may be mistaken for lower back pain.
Do Not Miss Diagnoses
- Abdominal Aortic Aneurysm (AAA): Although less common, an AAA can cause lower back pain, especially if it is expanding or leaking. This condition is life-threatening and requires immediate medical attention.
- Kidney Stones or Pyelonephritis: Pain from kidney stones or a kidney infection can radiate to the lower back, often on one side. These conditions require prompt diagnosis and treatment to prevent complications.
- Spinal Infection or Osteomyelitis: Infections of the spine can cause chronic back pain and are more serious conditions that need to be ruled out, especially in patients with risk factors such as immunocompromised states or recent spinal procedures.
Rare Diagnoses
- Sacroiliitis: Inflammation of the sacroiliac joints can cause lower back pain, often on one side, and is more commonly associated with inflammatory arthropathies like ankylosing spondylitis.
- Osteoid Osteoma: A benign bone tumor that can cause nocturnal pain which is relieved by NSAIDs. It's a rare cause of lower back pain but should be considered in cases where the pain has these characteristic features.
- Spinal Tumors: Both benign and malignant tumors can cause lower back pain, often with other systemic symptoms. While rare, they are important to consider in the differential diagnosis, especially with atypical pain patterns or significant weight loss.