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椎间盘性腰痛

最后审阅: 10 Nov 2024
最后更新: 16 Dec 2022

小结

定义

病史和体格检查

关键诊断因素

  • 持续性腰痛
  • 神经根性下肢痛
  • 活动相关症状
完整详情

其他诊断因素

  • 腰部运动受限
  • 直腿抬高阳性
  • 神经系统缺损(下肢无力,感觉缺失,膀胱及肠道症状)
完整详情

危险因素

  • 年龄增长
  • 基因影响
  • 职业(运输过程中的过度轴向负荷,震动)
  • 吸烟
  • 关节突关节面取向及关节炎
  • 异常骨盆形态
  • 矢状序列改变
  • 肥胖
  • 糖尿病
  • 动脉粥样硬化
完整详情

诊断性检查

首要检查

  • 直立位腰椎X线片
  • 脊柱 MRI 检查
完整详情

需考虑的检查

  • 脊柱 CT
  • 脊柱屈/伸位X线片
  • 单光子发射型计算机断层显像
  • 脊髓造影计算机断层扫描
  • 椎间盘造影
  • 磁共振钆(造影剂)成像
完整详情

新兴检查

  • 基因检测
  • 功能性脊柱成像

治疗流程

初步治疗

神经学急症(神经根功能受损或马尾综合征)

急症处理

急性背痛:从出现症状或慢性疼痛加重持续小于3个月

持续性治疗

慢性背痛:从出现症状起持续≥3个月

撰稿人

作者

Jwalant S. Mehta, MBBS, MS(Orth), D(Orth), MCh(Orth), FRCS(Orth)

Consultant Spine Surgeon

Royal Orthopaedic Hospital

Birmingham

UK

利益声明

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.

鸣谢

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.

同行评议者

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

利益声明

JT declares that he has no competing interests.

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.

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