Borenstein David
Arthritis and Rheumatism Associates, The George Washington University Medical Center, 2021 K Street, NW, Suite 300, Washington, DC 20006, USA.
Curr Rheumatol Rep. 2004 Feb;6(1):14-9. doi: 10.1007/s11926-004-0079-z.
The lumbar spine is a common location for osteoarthritis. The axial skeleton demonstrates the same classic alterations of cartilage loss, joint instability, and osteophytosis characteristic of symptomatic disease in the appendages. Despite these similarities, questions remain regarding the lumbar spine facet joints as a source of chronic back pain. The facet joints undergo a progression of degeneration that may result in pain. The facet joints have sensory input from two spinal levels that makes localization of pain difficult. Radiographic studies describe intervertebral disc abnormalities in asymptomatic individuals that are associated with, but not synonymous for, osteoarthritis. Patients who do not have osteoarthritis of the facet joints on magnetic resonance scan do not have back pain. Single photon emission computed tomography scans of the axial skeleton are able to identify painful facet joints with increased activity that may be helped by local anesthetic injections. Low back pain is responsive to therapies that are effective for osteoarthritis in other locations. Osteoarthritis of the lumbar spine does cause low back pain.
腰椎是骨关节炎的常见发病部位。中轴骨骼呈现出与附属肢体有症状疾病相同的典型软骨丢失、关节不稳定和骨赘形成改变。尽管有这些相似之处,但关于腰椎小关节作为慢性背痛来源仍存在疑问。小关节会经历退变过程,这可能导致疼痛。小关节从两个脊髓节段接收感觉输入,使得疼痛定位困难。影像学研究描述了无症状个体中与骨关节炎相关但不等同于骨关节炎的椎间盘异常。磁共振扫描显示小关节无骨关节炎的患者没有背痛。中轴骨骼的单光子发射计算机断层扫描能够识别活动增加的疼痛小关节,局部麻醉注射可能对此有帮助。下腰痛对其他部位骨关节炎有效的治疗方法有反应。腰椎骨关节炎确实会导致下腰痛。