Elder Benjamin D, Witham Timothy F
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Semin Neurol. 2016 Oct;36(5):456-461. doi: 10.1055/s-0036-1585071. Epub 2016 Sep 23.
Low back pain is highly prevalent, affecting a vast majority of the adult population at some point in their lifetime. Thorough history and physical examination is critically important in evaluating these patients and screening for potentially serious conditions. Imaging should be guided by the history and physical examination, particularly when there is concern for serious conditions and/or a focal neurological deficit present. Adequate treatment of patients with low back pain often requires a multidisciplinary approach, involving several medical specialties. Patients with acute axial low back pain typically have a favorable prognosis with resolution over 4 weeks, regardless of treatment. However, patients with chronic low back pain should be transitioned to pain management strategies with multidisciplinary care, in order to maximize function and limit disability. Referral to a spine surgeon is indicated urgently for a severe, progressive neurological deficit, particularly new motor weakness or cauda equina syndrome, and can be done electively for patients with degenerative disorders without a focal deficit.
腰痛非常普遍，在一生中的某个阶段影响着绝大多数成年人。全面的病史和体格检查对于评估这些患者以及筛查潜在的严重疾病至关重要。影像学检查应根据病史和体格检查来指导，特别是当担心存在严重疾病和/或存在局灶性神经功能缺损时。腰痛患者的充分治疗通常需要多学科方法，涉及多个医学专业。急性轴性腰痛患者通常预后良好，无论治疗如何，4周内即可缓解。然而，慢性腰痛患者应转向多学科护理的疼痛管理策略，以最大限度地提高功能并限制残疾。对于严重的、进行性神经功能缺损，特别是新出现的运动无力或马尾综合征，应紧急转诊至脊柱外科医生，对于无局灶性缺损的退行性疾病患者，可选择性转诊。
