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Give differential diagnosis
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Reading File
The image shows handwritten notes listing the differential diagnosis for Lumbar/Low Back Pain. Here is a complete, organized, and expanded differential diagnosis based on those notes:
Differential Diagnosis: Low Back Pain (Lumbar Region)
1. Degenerative Conditions
| Condition | Key Notes |
|---|---|
| Lumbar Spondylosis | Degenerative changes - osteophytes, disc space narrowing, facet joint arthritis; common in older adults |
| Lumbar Spondylolysis | Stress fracture/defect in the pars interarticularis (partial break); seen in young athletes |
| Lumbar Spondylolisthesis | Forward slip of one vertebra over another - classified Grades I-IV; can follow spondylolysis (full breakdown) |
| PIVD (Prolapsed Intervertebral Disc) | Disc herniation causing nerve root compression; classically presents with sciatica (radiation down the leg) |
2. Inflammatory / Autoimmune Conditions
| Condition | Key Notes |
|---|---|
| Ankylosing Spondylitis | Seronegative HLA-B27-associated inflammatory arthritis; bamboo spine on X-ray; worse in morning |
| Seronegative Spondyloarthropathy | Broader group including reactive arthritis, psoriatic arthritis, IBD-related arthritis, and undifferentiated SpA |
| Autoimmune Disorders | Rheumatoid arthritis (cervical > lumbar), SLE with musculoskeletal involvement |
3. Mechanical / Soft Tissue Conditions
| Condition | Key Notes |
|---|---|
| Muscle Strain | Acute onset, paraspinal tenderness, no neuro deficit; most common cause of acute LBP |
| Muscle Spasm | Often secondary to underlying pathology; palpable tightness |
| Ligament Sprain | Injury to interspinous, supraspinous, or iliolumbar ligaments |
4. Traumatic Conditions
| Condition | Key Notes |
|---|---|
| Fracture | Compression fracture (osteoporosis), burst fracture, chance fracture (flexion-distraction) |
| Dislocation | Rare in lumbar spine; associated with high-energy trauma |
5. Infective Conditions
| Condition | Key Notes |
|---|---|
| Pott's Disease (TB Spondylitis) | Mycobacterium tuberculosis; involves anterior vertebral body; gibbus deformity; psoas abscess |
| Osteomyelitis | Pyogenic (Staphylococcus aureus most common); fever, elevated ESR/CRP |
| Discitis | Infection of intervertebral disc; severe localized pain |
| Epidural Abscess | Urgent surgical emergency; can cause rapid neurological deterioration |
6. Neoplastic Conditions
| Condition | Key Notes |
|---|---|
| Primary Tumours | Osteoid osteoma (classic nocturnal pain, relieved by NSAIDs), giant cell tumour, osteosarcoma |
| Metastatic Disease | Breast, prostate, lung, kidney, thyroid - "Breast Kills Lung, Professor Thyroid" mnemonic |
| Multiple Myeloma | Punched-out lytic lesions; Bence Jones protein; elderly patient |
| Spinal Cord Tumours | Meningioma, neurofibroma, ependymoma |
7. Metabolic / Systemic Conditions
| Condition | Key Notes |
|---|---|
| Osteoporosis | Vertebral compression fractures; post-menopausal women; DEXA scan |
| Osteomalacia / Rickets | Vitamin D deficiency; looser zones on X-ray |
| Paget's Disease | Bone remodeling disorder; elevated ALP; cotton wool appearance on X-ray |
8. Referred Pain (Non-Spinal Causes)
| Condition | Key Notes |
|---|---|
| Renal Calculi / Pyelonephritis | Flank/loin pain; urinary symptoms |
| Aortic Aneurysm | Pulsatile mass; tearing pain; surgical emergency |
| Pancreatitis | Epigastric pain radiating to back; elevated amylase/lipase |
| Endometriosis / PID | Cyclical back pain in women |
| Prostatitis | Perineal and low back pain in men |
Red Flag Signs (Require Urgent Investigation)
- Night pain / pain at rest
- Age > 50 or < 20 with new onset
- Unexplained weight loss (malignancy)
- Fever (infection)
- Bladder/bowel dysfunction - Cauda Equina Syndrome (surgical emergency)
- History of malignancy
- Bilateral radicular symptoms
- Saddle anesthesia
The notes also include a line in Hindi/Devanagari script at the bottom - it appears to reference vertebral joint conditions (कशेरुकाओं की संधि - spinal joints/articulations), likely referring to facet joint pathology.
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