Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02120, USA.
Spine (Phila Pa 1976). 2013 Jul 1;38(15):1282-7. doi: 10.1097/BRS.0b013e31828f463e.
Comparative study using combined data from 2 prospective cohort studies.
To expose the differences between the clinical characteristics of neurogenic claudication from magnetic resonance image-documented lumbar spinal stenosis (LSS) and lumbosacral radicular syndrome from acute, magnetic resonance image-documented, lumbar disc herniation (LDH).
LSS and LDH are the common lumbar disorders that produce lower extremity pain. Though known factors such as pain induced by walking for LSS and the rapid onset of symptoms for LDH are useful for differentiating these disorders, exploration of differences in other factors has received limited study.
This study included participants aged 60 yr or older from 2 previous studies. One examined walking limitations caused by LSS and the second the natural history of LDH in elderly adults. The clinical features of both groups were compared by calculating means, medians, and standard deviations for continuous variables, and frequencies for categorical variables. χ test was used to explore differences between LSS and LDH for categorical variables, and Student t test or Mann-Whitney test for continuous variables.
Participants with LSS had more medical comorbidity, less intense leg pain, and less disability than those with LDH. Leg pain was more common in the anterior thigh, anterior knee and shin in LDH, and in the posterior knee in LSS. Trunk flexion was more impaired in LDH. Positive straight leg raising and femoral stretch signs were common in LDH, and rare in LSS. Abnormal Achilles reflexes were noted more frequently in LSS.
In addition to established factors, greater leg pain intensity, greater disability, and pain in the anterior leg are more common in the elderly with LDH than in the elderly with LSS. Normal trunk flexion, absence of nerve root tension signs and abnormal Achilles reflexes are more common in LSS.
使用 2 项前瞻性队列研究的合并数据进行的对比研究。
揭示磁共振成像（MRI）诊断的腰椎管狭窄症（LSS）所致神经源性跛行与 MRI 诊断的急性腰椎间盘突出症（LDH）所致腰神经根综合征之间的临床特征差异。
LSS 和 LDH 是常见的腰椎疾病，会引起下肢疼痛。尽管已知的一些因素，如 LSS 引起的行走疼痛和 LDH 症状的快速发作，对于区分这些疾病很有用，但对其他因素差异的探索研究较少。
本研究纳入了来自两项既往研究的 60 岁或以上的参与者。一项研究检查了 LSS 引起的行走受限，另一项研究检查了老年人群中 LDH 的自然病史。通过计算连续变量的平均值、中位数和标准差，以及分类变量的频率，比较两组的临床特征。χ²检验用于探索 LSS 和 LDH 之间的分类变量差异，Student t 检验或 Mann-Whitney 检验用于连续变量。
与 LDH 患者相比，LSS 患者的合并症更多，腿部疼痛较轻，残疾程度较轻。LDH 患者的腿部疼痛更常见于大腿前侧、膝盖前侧和小腿，而 LSS 患者的腿部疼痛更常见于膝盖后侧。LDH 患者的躯干弯曲度受损更严重。直腿抬高和股神经拉伸征在 LDH 中更为常见，而在 LSS 中则较为罕见。LSS 患者更常出现异常的跟腱反射。
除了已确立的因素外，与 LSS 患者相比，老年 LDH 患者的腿部疼痛强度更大、残疾程度更大、腿部疼痛更常见于前腿部。正常的躯干弯曲度、无神经根紧张征和异常的跟腱反射在 LSS 中更为常见。
3 级。
