Summary
Definition
History and exam
Key diagnostic factors
- dolor lumbar persistente
- dolor de piernas radicular
- síntomas relacionados con la actividad
Other diagnostic factors
- restricción en el movimiento lumbar
- prueba positiva de elevación de la pierna recta
- déficit neurológico (debilidad de las piernas, pérdida sensorial, síntomas en la vejiga y el intestino)
Risk factors
- mayor edad
- influencia genética
- ocupación (cargas axiales excesivas, vibraciones causadas por el transporte)
- tabaquismo
- tropismo de la articulación facetaria y artritis
- morfología pélvica anormal
- cambios en la alineación sagital
- obesidad
- diabetes mellitus
- aterosclerosis
Diagnostic investigations
1st investigations to order
- radiografía de la columna lumbar en bipedestación
- imagen de resonancia magnética (IRM) de columna
Investigations to consider
- tomografía computarizada (TC) de columna
- radiografías de columna en flexión/extensión
- tomografía computarizada por emisión de fotón único
- mielograma por TC
- discografía
- IRM con gadolinio (contraste)
Emerging tests
- pruebas genéticas
- estudios por imágenes funcionales de la columna
Treatment algorithm
emergencia neurológica (déficit de la raíz nerviosa o síndrome de la cola de caballo)
dolor de espalda agudo: duración <3 meses desde la presentación inicial o exacerbación del dolor crónico
dolor crónico de espalda: duración ≥3 meses desde la presentación inicial
Contributors
Authors
Jwalant S. Mehta, MBBS, MS(Orth), D(Orth), MCh(Orth), FRCS(Orth)
Consultant Spine Surgeon
Royal Orthopaedic Hospital
Birmingham
UK
Disclosures
JSM declares that he has received research support from Stryker K2M, Depuy Synthes and Nuvasive; is a speaker for AO Spine and Scoliosis Research Society; serves on the editorial board for the European Spine Journal, the Spine Deformity Journal, and the Bone Joint Journal, is a reviewer for the Global Spinal Journal, and is part of the Paediatric Spine Study Group.
Acknowledgements
Dr Jwalant S. Mehta would like to gratefully acknowledge Dr Giannoulis Kyriakos and Dr Nasir Quiraishi, previous contributors to this topic. GK and NQ declare that they have no competing interests.
Peer reviewers
Jayesh Trivedi, FRCS (Orth)
Consultant Spine Surgeon and Head of Department
Centre for Spinal Studies
Robert Jones and Agnes Hunt Hospital NHS Foundation Trust
Oswestry
Alder Hey University Children's Hospital
Liverpool
UK
Declarações
JT declares that he has no competing interests.
John Ratliff, MD, FAANS, FACS
Associate Professor
Department of Neurosurgery
Stanford University
Stanford
CA
Declarações
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.
Referências
Principais artigos
Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014 Jan;14(1):180-91. Resumo
National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. Dec 2020 [internet publication].Texto completo
Expert Panel on Neurological Imaging, Hutchins TA, Peckham M, et al. ACR Appropriateness Criteria® Low Back Pain: 2021 Update. J Am Coll Radiol. 2021 Nov;18(11s):S361-S379.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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