Spinal stenosis: pathophysiology, clinical and radiologic classification.
Spinal stenosis: pathophysiology, clinical and radiologic classification.
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椎管狭窄：病理生理学、临床和放射学分类。
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发表时间：
2005
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通讯作者：
E. Truumees
中科院分区：
文献类型：
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作者：
E. Truumees
椎管狭窄是指中空管变窄，在本例中是指中央腰椎管、侧隐窝或椎间孔。临床上，这种狭窄会产生神经血管压迫，可能导致疼痛。腰椎管狭窄症可以根据病因（例如，先天性或获得性）或症状复杂（神经根病，神经源性跛行或机械性背痛）进行分类。狭窄也可以通过放射学分类，通过狭窄的位置（例如，中央管，侧隐窝或椎间孔）或通过存在畸形，如脊椎前移或脊柱侧凸。在这些分类方案中发生重叠，因为中央狭窄伴硬膜囊压迫通常导致神经源性跛行，而侧隐窝压迫与单个神经根压迫相关，因此导致神经根病。由于与椎管狭窄相关的影像学改变在衰老过程中非常常见，因此了解腰椎管狭窄症的病理生理学对于评估和处理相关的综合症状至关重要。虽然症状可能是由椎管狭窄引起的，但并不是所有椎管狭窄的患者都会出现症状。为什么有些患者会出现症状性狭窄而另一些则没有，原因尚不清楚。因此，术语腰椎管狭窄症不是指椎管狭窄的病理解剖学发现，而是指由神经元件或其血液供应的机械压迫引起的下肢疼痛的临床综合征。
Stenosis is the narrowing of a hollow tube, in this case the central lumbar spinal canal, lateral recess, or foramen. Clinically, this narrowing produces neurovascular compression that may lead to pain. Lumbar spinal stenosis may be classified by etiology (for example, congenital or acquired) or by symptom complex (radiculopathy, neurogenic claudication, or mechanical back pain). Stenosis can also be classified radiographically, by the location of the stenosis (for example, central canal, lateral recess, or intervertebral foramen) or by the presence of deformity such as spondylolisthesis or scoliosis. Overlap occurs in these schemes of classification in that central stenosis with thecal sac compression typically leads to neurogenic claudication, whereas lateral recess compression is associated with compression of an individual nerve root and, therefore, radiculopathy. Because radiographic changes associated with stenosis are very common with aging, understanding the pathophysiology of lumbar spinal stenosis is critical in the assessment and management of related symptom complexes. Although symptoms may arise from narrowing of the spinal canal, not all patients with narrowing develop symptoms. The reason why some patients develop symptomatic stenosis and others do not is still unknown. Therefore, the term lumbar spinal stenosis refers not to the pathoanatomic finding of spinal canal narrowing, but rather to a clinical syndrome of lower extremity pain caused by mechanical compression on the neural elements or their blood supply.