Progressive Neurological Symptoms in Young Adult with Degenerative Disc Disease

Case at a Glance

A 29-year-old female with known degenerative disc disease and spondylitis presents with acute worsening of radicular pain extending beyond her typical pattern, raising concerns for neurological progression.

Patient's Story

The patient has an established diagnosis of degenerative disc disease affecting the lumbar spine with associated spondylitis. Over the past week, she experienced a significant escalation in her chronic pain syndrome. The pain, which typically remained localized to her lower back with some radiation to hips and thighs, has now progressed distally to involve her knees and, more concerning, has extended into her shins bilaterally. She describes this new pain pattern as distinctly different from her baseline chronic pain and significantly more severe. The patient has autism spectrum disorder, which affects her ability to communicate pain severity using standard pain scales. She reports having an unusually high pain tolerance, which has historically led to delayed recognition of serious conditions requiring medical intervention.

Initial Assessment

The patient presented with acute-on-chronic lower back pain with new neurological distribution. Her baseline condition includes lumbar degenerative disc disease with inflammatory spondylitis. The extension of radicular symptoms to the lower legs represents a concerning change from her established pain pattern.

The Diagnostic Journey

The patient faced a decision point regarding seeking emergency care versus waiting for her scheduled pain management appointment in early August. Her unique presentation was complicated by her autism spectrum disorder affecting pain perception and communication, as well as her documented history of abnormally high pain tolerance. Previous emergency department visits had revealed imaging findings that were incongruent with her reported pain levels, leading to clinical surprise at her functional status despite significant structural abnormalities.

Final Diagnosis

Degenerative disc disease with spondylitis and acute worsening of lumbar radiculopathy, with new symptoms suggestive of possible L4-L5 or L5-S1 nerve root involvement extending to tibial distribution.

Treatment Plan

Given the new neurological symptoms extending below the knee, emergency evaluation was recommended to rule out cauda equina syndrome or significant nerve root compression. Imaging studies including MRI would be indicated to assess for interval changes in disc herniation or spinal stenosis. Pain management consultation remained planned for comprehensive long-term care coordination.

Outcome and Follow-up

The case highlights the complexity of managing chronic pain conditions in patients with atypical pain perception and communication differences. Regular monitoring for progressive neurological symptoms is essential, with clear protocols established for recognizing warning signs that warrant immediate medical attention despite the patient's tendency to minimize symptoms.