Low Back and Neck Pain
Low Back and Neck Pain
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DOI：
10.1007/978-1-84800-934-9_45
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发表时间：
2009-01-01
期刊：
影响因子：
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通讯作者：
Schwab, Joseph H.
中科院分区：
文献类型：
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作者：
Dixit, Rajiv K.;Schwab, Joseph H.
腰痛腰痛 (LBP) 会影响下肋骨和臀皱襞之间的区域，即使没有神经根受累，也经常会放射到大腿。大约 80% 的人在一生中的某个阶段会受到腰痛的影响。腰椎退行性改变是最常见的原因。尽管复发很常见，但这些患者中 90% 以上大多在 8 周内不再疼痛。初步评估应侧重于识别少数患有神经系统受累、骨折或可能的全身性疾病（感染、恶性肿瘤或脊柱关节炎）的患者。这些患者可能需要紧急干预或特定的药物治疗。椎管狭窄是由凸出的椎间盘、肥大的小关节囊、骨赘和凸出的黄韧带侵犯脊神经引起的。如果没有提示神经系统受累、骨折或可能的全身性疾病的“危险信号”，腰痛患者很少需要进行早期影像学检查。 异常，通常是与年龄相关的退行性变化的结果，应该仔细解释，因为它们经常出现在无症状个体中。高达 85% 的患者无法进行精确的病理解剖学诊断并识别疼痛发生器。持续性 LBP 应该采用单独定制的治疗方案，包括镇痛、核心强化、伸展、有氧调节、减轻多余体重和患者教育。没有证据表明 硬膜外糖皮质激素注射对于没有继发于椎间盘突出症的神经根病的患者的疗效。大量注射技术、物理治疗方式和非手术介入治疗缺乏疗效证据。背部手术的主要适应症是存在严重或进行性神经功能缺损。在没有神经功能缺损的情况下，背部手术 手术（尤其是针对退行性病变的脊柱融合术）并不比保守治疗更有效。颈部疼痛颈部疼痛在一生中的某个时刻影响着大约 70% 的人口。颈部疼痛通常影响颈部后部，即使没有神经根或脊髓受累，也经常放射到肩胛骨和三角肌。颈部疼痛的临床特征和治疗有很多相似之处。 患有颈部疼痛和腰痛的患者。
Low back painLow back pain (LBP) affects the area between the lower rib cage and gluteal folds and frequently radiates into the thighs even in the absence of nerve root involvement.Low back pain affects approximately 80% of individuals at some point in their lives. Degenerative changes of the lumbar spine are the most common cause.More than 90% of these patients are mostly pain free within 8 weeks, although recurrences are common.The initial evaluation should focus on identification of the few patients with neurological involvement, fracture, or possible systemic disease (infection, malignancy, or spondyloarthritis). These patients may need urgent intervention or a specific medical treatment.Spinal stenosis is caused by encroachment upon the spinal nerves by bulging intervertebral discs, hypertrophied facet capsules, osteophytes, and bulging ligamentum flavum.Early imaging in patients with LBP is rarely indicated in the absence of “red flags” that suggest neurologic involvement, fracture, or possible systemic disease.Imaging abnormalities, often the result of age-related degenerative changes, should be interpreted carefully because they are frequently present in asymptomatic individuals.A precise pathoanatomic diagnosis with identification of the pain generator cannot be made in up to 85% of patients.Persistent LBP should be treated with an individually tailored program that includes analgesia, core strengthening, stretching, aerobic conditioning, loss of excess weight, and patient education.There is no evidence for the efficacy of epidural glucocorticoid injections in patients who do not have radiculopathy secondary to disk herniation.A large number of injection techniques, physical therapy modalities, and nonsurgical interventional therapies lack evidence of efficacy.The major indication for back surgery is the presence of a serious or progressive neurological deficit.In the absence of neurologic deficits, back surgery—particularly spinal fusion for degenerative changes—is not more effective than conservative care.Neck painNeck pain affects approximately 70% of the population at some point in their lives.Neck pain typically affects the posterior aspect of the neck and frequently radiates into the shoulder blades and deltoid muscles even in the absence of nerve root or spinal cord involvement.There are a remarkable number of similarities in the clinical features and management of patients with neck pain and LBP.