小结
定义
病史和体格检查
关键诊断因素
- onset and duration of symptoms
- back pain
- activity-related back pain
- leg pain when walking
- stooped posture when walking
- leg numbness or paresthesias
- absence of exam findings
其他诊断因素
- pain radiating down the leg
- bladder or bowel dysfunction
- muscle weakness or wasting
危险因素
- age over 40 years
- manual labor
- previous back surgery
- family history of back pain
- smoking
- diabetes mellitus
- peripheral vascular occlusive disease
- previous injury
- achondroplasia
- acromegaly
诊断性检查
首要检查
- plain x-ray
- MRI (T2-weighted)
需考虑的检查
- CT myelography
- CT spine
- electromyographic (EMG) walking test
- electromyographic paraspinal mapping
治疗流程
significant acute neurologic deficit
no significant acute neurologic deficit: pain affecting quality of life and/or functional activities
chronic symptoms
撰稿人
作者
Michael David Tseng MD, MD
Clinical Assistant Professor
Department of Orthopaedic Surgery
Stanford University School of Medicine
Stanford
CA
利益声明
MDT declares that he has no competing interests.
鸣谢
Dr Michael David Tseng would like to gratefully acknowledge Dr Adam M. Pearson, Dr William A. Abdu, Dr John K. Houten, and Dr Mark Chwajol, previous contributors to this topic. WAA is an author of a reference cited in this topic. JKH and MC declare that they have no competing interests.
利益声明
WAA and AMP are authors of references cited in this topic. JKH and MC declared that they had no competing interests.
同行评议者
John Ratliff, MD, FAANS, FACS
Associate Professor
Department of Neurosurgery
Stanford University
Stanford
CA
利益声明
JR declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop Relat Res. 1982 May;(165):110-23. 摘要
Jane JA Sr, Jane JA Jr, Helm GA, et al. Acquired lumbar spinal stenosis. Clin Neurosurg. 1996;43:275-99. 摘要
Garfin SR, Herkowitz HN, Mirkovic S. Nonoperative and operative treatment of lumbar stenosis. In: Rothman R, Simeone F, eds. The spine. 3rd ed. Philadelphia, PA: WB Saunders; 1991:857-75.
Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976). 2010 Jun 15;35(14):1329-38.全文 摘要
Zdeblick TA. The treatment of degenerative lumbar disorders: a critical review of the literature. Spine (Phila Pa 1976). 1995 Dec 15;20(24 Suppl):126S-37S. 摘要
Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med. 2007 May 31;356(22):2257-70.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Peripheral vascular disease
- Lumbosacral intervertebral disk herniation
- Spinal compression fracture
更多 鉴别诊断指南
- Natural course and diagnosis of lumbar spinal stenosis: WFNS Spine Committee recommendations
- ISSLS prize winner: consensus on the clinical diagnosis of lumbar spinal stenosis: results of an international delphi study
更多 指南患者教育信息
Spinal stenosis
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