Gautschi O P, Cadosch D, Hildebrandt G
Klinik für Neurochirurgie, Kantonsspital St. Gallen, St. Gallen.
Praxis (Bern 1994). 2008 Mar 19;97(6):305-12. doi: 10.1024/1661-8157.97.6.305.
Acute low back pain is one of the most frequent reason for an emergency or primary care physician visit. Up to 90% of all adults will experience an episode of back pain at some point during their lifetime. Although the majority of patients have uncomplicated benign presentation and 80-90% recover within 4 to 6 weeks, there is a small subset who has an underlying potential life-threatening etiology. Among them are aortic dissection, ruptured abdominal aortic aneurysm, vertebral osteomyelitis, spinal epidural abscess and the cauda equina syndrome (CES). The latter entails a compression of the nerve roots of the cauda equina. These patients usually present post-traumatically with the clinical triad of saddle anesthesia, bowel or bladder dysfunction and muscular weakness of the lower extremeties. A delayed diagnosis can result in a significantly increased morbidity. Therefore, early diagnosis and the initiation of the appropriate therapeutic steps are essential. A thourough anamnesis and physical examination are leading to the suspected diagosis. Below, clinical presentation, diagnosis and relevant treatment of the CES are discussed.
急性下背痛是急诊或初级保健医生接诊的最常见原因之一。高达90%的成年人在其一生中的某个时候会经历一次背痛发作。尽管大多数患者表现为不复杂的良性症状，80%至90%的患者会在4至6周内康复，但仍有一小部分患者存在潜在的危及生命的病因。其中包括主动脉夹层、腹主动脉瘤破裂、椎体骨髓炎、脊髓硬膜外脓肿和马尾综合征（CES）。后者是指马尾神经根受压。这些患者通常在创伤后出现鞍区感觉缺失、肠道或膀胱功能障碍以及下肢肌肉无力的临床三联征。延迟诊断会导致发病率显著增加。因此，早期诊断和启动适当的治疗措施至关重要。全面的病史采集和体格检查有助于做出疑似诊断。以下将讨论CES的临床表现、诊断及相关治疗。
