Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland.
Best Pract Res Clin Rheumatol. 2010 Apr;24(2):253-65. doi: 10.1016/j.berh.2009.11.001.
Lumbar spinal stenosis (LSS) is most commonly due to degenerative changes in older individuals. LSS is being more commonly diagnosed and may relate to better access to advanced imaging and to an ageing population. This review focusses on radicular symptoms related to degenerative central and lateral stenosis and updates knowledge of LSS pathophysiology, diagnosis and management. Since patients with anatomic LSS can range from asymptomatic to severely disabled, the clinical diagnosis focusses on symptoms and examination findings associated with LSS. Imaging findings are helpful for patients with persistent, bothersome symptoms in whom invasive treatments are being considered. There is limited information from high-quality studies about the relative merits and demerits of commonly used treatments. Interpreting and comparing results of available research are limited by a lack of consensus about the definition of LSS. Nevertheless, evidence supports decompressive laminectomy for patients with persistent and bothersome symptoms. Recommendations favour a shared decision-making approach due to important trade-offs between alternative therapies and differences among patients in their preferences and values.
腰椎管狭窄症（LSS）最常见于老年人的退行性改变。LSS 的诊断更为常见，可能与更先进的影像学检查的普及以及人口老龄化有关。本篇综述重点介绍与退行性中央和侧方狭窄相关的神经根症状，并更新 LSS 病理生理学、诊断和治疗方面的知识。由于解剖学上存在 LSS 的患者可以从无症状到严重残疾，因此临床诊断侧重于与 LSS 相关的症状和检查结果。对于持续存在且令人困扰的症状且正在考虑侵入性治疗的患者，影像学检查结果具有帮助。关于常用治疗方法的优缺点，高质量研究提供的信息有限。由于对 LSS 的定义缺乏共识，因此对现有研究结果的解释和比较受到限制。尽管如此，对于持续存在且令人困扰的症状的患者，减压椎板切除术的证据仍然支持。由于替代疗法之间存在重要的权衡，并且患者在偏好和价值观方面存在差异，因此推荐采用共同决策方法。
