Czabanka M, Thomé C, Ringel F, Meyer B, Eicker S-O, Rohde V, Stoffel M, Vajkoczy P
Klinik und Poliklinik für Neurochirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich.
Nervenarzt. 2018 Jun;89(6):639-647. doi: 10.1007/s00115-018-0523-3.
Degenerative diseases of the lumbar spine and associated lower back pain represent a major epidemiological and health-related economic challenge. A distinction is made between specific and unspecific lower back pain. In specific lower back pain lumbar disc herniation and spinal canal stenosis with or without associated segment instability are among the most frequent pathologies. Diverse conservative and operative strategies for treatment of these diseases are available.
The aim of this article is to present an overview of current data and an evidence-based assessment of the possible forms of treatment.
An extensive literature search was carried out via Medline plus an additional evaluation of the authors' personal experiences.
Conservative and surgical treatment represent efficient treatment options for degenerative diseases of the lumbar spine. Surgical treatment of lumbar disc herniation shows slight advantages compared to conservative treatment consisting of faster recovery of neurological deficits and a faster restitution of pain control. Surgical decompression is superior to conservative measures for the treatment of spinal canal stenosis and degenerative spondylolisthesis. In this scenario conservative treatment represents an important supporting measure for surgical treatment in order to improve the mobility of patients and the outcome of surgical treatment.
The treatment of specific lower back pain due to degenerative lumbar pathologies represents an interdisciplinary challenge, requiring both conservative and surgical treatment strategies in a synergistic treatment concept in order to achieve the best results for patients.
腰椎退行性疾病及相关的下背痛是重大的流行病学和健康相关经济挑战。下背痛分为特异性和非特异性两种。在特异性下背痛中，腰椎间盘突出症以及伴有或不伴有相关节段不稳定的椎管狭窄是最常见的病理情况。针对这些疾病有多种保守和手术治疗策略。
本文旨在概述当前数据，并对可能的治疗方式进行循证评估。
通过医学文献数据库（Medline）进行广泛的文献检索，并额外评估作者的个人经验。
保守治疗和手术治疗都是腰椎退行性疾病的有效治疗选择。与保守治疗相比，腰椎间盘突出症的手术治疗具有一些轻微优势，包括神经功能缺损恢复更快以及疼痛控制恢复更快。手术减压在治疗椎管狭窄和退行性椎体滑脱方面优于保守措施。在这种情况下，保守治疗是手术治疗的重要辅助措施，以改善患者的活动能力和手术治疗效果。
因腰椎退行性病变导致的特异性下背痛的治疗是一项跨学科挑战，需要在协同治疗理念中结合保守和手术治疗策略，以便为患者取得最佳效果。
