Резюме
Определение
Анамнез и осмотр
Ключевые диагностические факторы
- lombalgia persistente
- dor radicular nas pernas
- sintomas relacionados à atividade
Другие диагностические факторы
- restrição no movimento lombar
- elevação da perna em linha reta positiva
- deficit neurológico (fraqueza nas pernas, perda sensorial, sintomas vesicais e intestinais)
Факторы риска
- idade mais avançada
- influência genética
- ocupação (cargas axiais excessivas, vibrações decorrentes de transporte)
- tabagismo
- tropismo de facetas articulares e artrite
- morfologia pélvica anormal
- alterações no alinhamento sagital
- obesidade
- diabetes mellitus
- aterosclerose
Диагностические исследования
Исследования, которые показаны в первую очередь
- radiografia da coluna lombar em posição ortostática
- RNM da coluna vertebral
Исследования, проведение которых нужно рассмотреть
- tomografia computadorizada (TC) da coluna vertebral
- radiografias de flexão/extensão da coluna vertebral
- tomografia computadorizada por emissão de fóton único
- mielografia por tomografia computadorizada (TC)
- discografia
- RNM com gadolínio (contraste)
Неотложные исследования
- teste genético
- exames de imagem funcionais da coluna vertebral
Алгоритм лечения
emergência neurológica (deficiência da raiz nervosa ou síndrome da cauda equina)
dorsalgia aguda: intervalo <3 meses desde a apresentação inicial ou exacerbação de dor crônica
dorsalgia crônica: intervalo ≥3 meses desde a apresentação inicial
Составители
Авторы
Jwalant S. Mehta, MBBS, MS(Orth), D(Orth), MCh(Orth), FRCS(Orth)
Consultant Spine Surgeon
Royal Orthopaedic Hospital
Birmingham
UK
Раскрытие информации
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.
Выражение благодарностей
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.
Рецензенты
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
Раскрытие информации
JT declares that he has no competing interests.
John Ratliff, MD, FAANS, FACS
Associate Professor
Department of Neurosurgery
Stanford University
Stanford
CA
Раскрытие информации
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.
Список литературы
Основные статьи
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. Аннотация
National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. Dec 2020 [internet publication].Полный текст
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.Полный текст Аннотация
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Отличия
- Tumor da medula espinhal
- Infecção da coluna vertebral
- Dorsalgia postural
Больше ОтличияРекомендации
- CDC prescribing opioids for pain
- ACR appropriateness criteria: low back pain
Больше РекомендацииЛифлеты для пациента
Dorsalgia: perguntas a fazer ao seu médico
Hérnia de disco: perguntas a fazer ao seu médico
Больше Лифлеты для пациента
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