History:
43-year-old, 5’6”, 140 lb female with a long history of low back pain, which started after she was thrown from a moped and her left hip hit a curb while vacationing in Bermuda fifteen years earlier. The back pain had become progressively more severe in the two years before her initial evaluation.

Symptoms:
She was experiencing constant pain with periodic sharp pain in her lower back and left buttock. There wasn’t any referred pain in her lower legs, i.e., sciatica. She had difficulty with lifting, and when she did, she experienced severe pain, which would make her knees buckle. She could only lie on her side and was unable to lie supine. She had difficulty sleeping. Since she could only sleep on her side, she often rolled onto her abdomen during sleep. She was much worse in the morning if she did this. She found that extending backward, bending forward, sitting, walking on a treadmill, side bending, lifting, pushing, and pulling all aggravated her pain. By far the worst position for her was full forward bending. She found she had difficulty getting in and out of this position. Morning stiffness could last up to two hours. but she was cleared of any systemic arthritic process such as ankylosing spondylitis, psoriatic arthritis, and RA with testing by her MD. She had no bowel or bladder complaints or incontinence. Coughing and sneezing aggravated her pain, and she had to brace for a sneeze, or she would experience sharp, severe pain. She was better by the evening.

Medication: Celebrex, Motrin

Past History: Generally healthy but did have surgery to remove 18 large fibroids (uterine tumors), which improved her back pain for a short period.

Occupation: Flight attendant, which required pushing and pulling of an 80-pound cart, assisting with heavy luggage into overhead compartments, and repeated bending and reaching.

Avocation activities: Gardening and yard work.

Question: What potential differential diagnoses should be considered based on this history?