Pfirrmann C W, Hodler J, Boos N
Orthopädische Universitätsklinik Balgrist, Zürich.
Praxis (Bern 1994). 1999 Feb 18;88(8):315-21.
The diagnostic assessment of low back pain should predominantly be based on history and clinical examination rather than on imaging studies. The problem of diagnostic imaging in low back pain is related to the high rate of asymptomatic morphological alterations in the lumbar spine. The diagnosis should therefore not be guided by findings in imaging. The imaging studies (standard radiographs and MRI) should verify the clinically suspected diagnosis and further lead to imaging guided injection studies (e.g. nerve root block, facet joint block, sacro-iliac joint block, provocative discography) to differentiate between symptomatic and asymptomatic morphological alterations. With longlasting local anaesthetics and steroids it is possible to achieve a diagnostic as well as a therapeutic effect.
下腰痛的诊断评估应以病史和临床检查为主，而非影像学检查。下腰痛诊断性影像学检查的问题在于腰椎无症状形态学改变的发生率较高。因此，诊断不应以影像学检查结果为导向。影像学检查（标准X线片和磁共振成像）应证实临床怀疑的诊断，并进一步引导进行影像引导下的注射研究（如神经根阻滞、小关节阻滞、骶髂关节阻滞、激发性椎间盘造影），以区分有症状和无症状的形态学改变。使用长效局部麻醉药和类固醇有可能达到诊断和治疗效果。
