What Is the Source of Chronic Low Back Pain and Does Age Play a Role?
What Is the Source of Chronic Low Back Pain and Does Age Play a Role?
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DOI：
10.1111/j.1526-4637.2010.01045.x
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发表时间：
2011-01-01
期刊：
影响因子：
3.1
通讯作者：
Saullo, Thomas
中科院分区：
文献类型：
--
作者：
DePalma, Michael J.;Ketchum, Jessica M.;Saullo, Thomas
目的：本研究的目的是评估腰椎间盘内破裂（IDD）、小关节疼痛（FJP）、骶髂关节疼痛（SIJP）、脊柱和骨盆功能不全骨折、棘间韧带损伤/Baastrup病的患病率、平均年龄以及患病率与年龄的关系，设计：本研究设计为回顾性病历回顾。设置：本研究设置在一个学术脊柱中心。对358例患者的378例病例进行了回顾，其中156例患者的170例病例接受了诊断性手术。介入：椎间盘造影，双重诊断性小关节阻滞，关节内骶髂关节注射，疼痛棘间韧带/对侧棘突/后路融合硬件的麻醉注射，结果测量结果分析了每个诊断组的患病率和年龄。方法：顽固性腰痛患者根据其临床表现进行诊断，结果：椎间盘内破裂、小关节疼痛和骶髂关节疼痛的患病率分别为42%、31%和18%。椎间盘内破裂的患者明显比小关节疼痛或骶髂关节疼痛的患者年轻。随着年龄的增长，椎间盘内破裂的可能性降低，小关节疼痛和骶髂关节疼痛作为腰痛源的可能性增加，直到70岁左右。结论：我们的数据证实椎间盘是成人慢性腰痛最常见的病因。根据我们的样本，患者越年轻，腰痛越有可能是椎间盘源性的。面源性或骶髂关节疼痛更可能发生在老年患者中。
Objective.The objective of this study was to estimate the prevalence, mean age, and association of prevalence and age of lumbar internal disc disruption (IDD), facet joint pain (FJP), sacroiliac joint pain (SIJP), spinal and pelvic insufficiency fractures, interspinous ligament injury/Baastrup's Disease, and soft tissue irritation by fusion hardware.Design.The study's design was a retrospective chart review.Setting.The study was set in an academic spine center.Patients.A total of 378 cases from 358 patients were reviewed of which 170 cases from 156 patients who underwent diagnostic procedures were included.Interventions.Discography, dual diagnostic facet joint blocks, intra-articular sacroiliac joint injections, anesthetic injections of painful interspinous ligaments/opposing spinous processes/posterior fusion hardware, or percutaneous augmentation were performed.Outcome Measures.Prevalence and age were analyzed for each diagnosis group.Methods.Patients with recalcitrant low back pain underwent diagnostic procedures based on their clinical presentation until the pain source was identified.Results.The prevalence of internal disc disruption, facet joint pain and sacroiliac joint pain was 42%, 31%, and 18%, respectively. Patients with internal disc disruption were significantly younger than those with facet joint pain or sacroiliac joint pain. Increased age was associated with a decreased probability of internal disc disruption and increased probabilities of facet joint pain and sacroiliac joint pain as the source of low back pain until approximately age 70.Conclusion.Our data confirm the intervertebral disc as the most common etiology of chronic low back pain in adults. Based on our sample, the younger the patient, the more likely low back pain is discogenic in origin. Facetogenic or sacroiliac joint pain is more likely in older patients.