Differential Diagnosis for Lower Lumbar Facet Osteoarthropathy and Degenerative Disc Disease
Single Most Likely Diagnosis
- Lumbar Spondylosis: Given the presence of lower lumbar facet osteoarthropathy and advanced degenerative disc disease at L4-5 and L5-S1, lumbar spondylosis is the most likely diagnosis. This condition is characterized by degenerative changes in the lumbar spine, including facet joint osteoarthritis and disc degeneration, which can lead to symptoms such as lower back pain, stiffness, and limited mobility.
Other Likely Diagnoses
- Lumbar Disc Herniation: The advanced degenerative disc disease noted at L4-5 and L5-S1 increases the risk of disc herniation, which could cause symptoms such as radiculopathy, sciatica, and worsening back pain.
- Lumbar Spinal Stenosis: The combination of facet osteoarthropathy and degenerative disc disease can lead to narrowing of the lumbar spinal canal, causing symptoms like neurogenic claudication, pain, and weakness in the legs.
- Spondylolisthesis: The grade 1 anterolisthesis of L5 relative to S1 suggests a possible diagnosis of spondylolisthesis, which can cause back pain, stiffness, and neurological symptoms due to the slipping of one vertebra over another.
Do Not Miss Diagnoses
- Cauda Equina Syndrome: Although less likely, cauda equina syndrome is a serious condition that requires immediate attention. It can be caused by severe lumbar disc herniation or other space-occupying lesions, leading to symptoms like severe back pain, sciatica, bladder and bowel dysfunction, and sensory loss in the lower limbs.
- Spinal Infection (e.g., Discitis or Osteomyelitis): Infection in the spine can present with back pain and neurological symptoms, and it is crucial to consider this diagnosis, especially if there are signs of infection or a compromised immune system.
- Spinal Tumor: Tumors in the lumbar spine can cause back pain, neurological symptoms, and systemic symptoms like weight loss. Although rare, this diagnosis should not be missed due to its significant implications.
Rare Diagnoses
- Ankylosing Spondylitis: A chronic inflammatory disease that can cause back pain and stiffness, ankylosing spondylitis is less common but should be considered, especially in younger patients with a history of inflammatory back pain.
- Spondyloarthritis: Other forms of spondyloarthritis, such as psoriatic arthritis or reactive arthritis, can also affect the lumbar spine and cause back pain, stiffness, and neurological symptoms.