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
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）
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
诊断性检查
首要检查
- 直立位腰椎X线片
- 脊柱 MRI 检查
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
新兴检查
- 基因检测
- 功能性脊柱成像
治疗流程
神经学急症（神经根功能受损或马尾综合征）
急性背痛：从出现症状或慢性疼痛加重持续小于3个月
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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