Quraishi N A, Taherzadeh O, McGregor A H, Hughes S P F, Anand P
Peripheral Neuropathy Unit, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK.
J Bone Joint Surg Br. 2004 Jan;86(1):74-80.
We studied 27 patients with low back pain and unilateral L5 or S1 spinal nerve root pain. Significant radiological changes were restricted to the symptomatic root level, when compared with controls. Low back and leg pain were graded on a visual analogue scale. Dermatomal quantitative sensory tests revealed significant elevations of warm, cool and touch perception thresholds in the affected dermatome, compared with controls. These elevations correlated with root pain (warm v L5 root pain; r = 0.88, p < 0.0001), but not with back pain. Low back pain correlated with restriction of anteroposterior spinal flexion (p = 0.02), but not with leg pain. A subset of 16 patients underwent decompressive surgery with improvement of pain scores, sensory thresholds and spinal mobility. A further 14 patients with back pain, multilevel nerve root symptoms and radiological changes were also studied. The only correlation found was of low back pain with spinal movement (p < 0.002). We conclude that, in patients with single level disease, dermatomal sensory threshold elevation and restriction of spinal movement are independent correlates of sciatica and low back pain.
我们研究了27例患有腰痛和单侧L5或S1脊神经根疼痛的患者。与对照组相比，显著的放射学改变局限于有症状的神经根水平。腰腿痛采用视觉模拟评分法进行分级。与对照组相比，皮节定量感觉测试显示受累皮节的温觉、冷觉和触觉感知阈值显著升高。这些升高与神经根疼痛相关（温觉与L5神经根疼痛；r = 0.88，p < 0.0001），但与背痛无关。腰痛与脊柱前后屈伸受限相关（p = 0.02），但与腿痛无关。16例患者接受了减压手术，疼痛评分、感觉阈值和脊柱活动度均有改善。还研究了另外14例有背痛、多节段神经根症状和放射学改变的患者。唯一发现的相关性是腰痛与脊柱活动相关（p < 0.002）。我们得出结论，在单节段疾病患者中，皮节感觉阈值升高和脊柱活动受限是坐骨神经痛和腰痛的独立相关因素。
