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Spinal stenosis

最后审阅: 19 Aug 2025
最后更新: 14 Dec 2021

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
完整详情

其他诊断因素

  • pain radiating down the leg
  • bladder or bowel dysfunction
  • muscle weakness or wasting
完整详情

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
完整详情

诊断性检查

首要检查

  • plain x-ray
  • MRI (T2-weighted)
完整详情

需考虑的检查

  • CT myelography
  • CT spine
  • electromyographic (EMG) walking test
  • electromyographic paraspinal mapping
完整详情

治疗流程

急症处理

significant acute neurologic deficit

no significant acute neurologic deficit: pain affecting quality of life and/or functional activities

持续性治疗

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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.
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