Gómez Vega Juan Carlos, Acevedo-González Juan Carlos
Departamento de Neurociencias, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia.
Departamento de Neurociencias, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia.
Neurocirugia (Engl Ed). 2019 May-Jun;30(3):133-143. doi: 10.1016/j.neucir.2018.05.004. Epub 2018 Jun 14.
Lumbar pain affects between 60-90% of people. It is a frequent cause of disability in adults. Pain may be generated by different anatomical structures such as the facet joint. However, nowadays pain produced by the facet joint has no clinical diagnosis. Therefore, the purpose of this article is to propose a clinical diagnostic scale for lumbar facet syndrome.
The study was conducted by means of 6 phases as follows, Phase 1, a systematic review of the literature was performed regarding the clinical diagnosis of facet-based lumbar pain based on the PRISMA checklist; Phase 2, a list of signs and symptoms proposed for diagnosis lumbar pain of facet origin was made. Phase 3, the list of signs and symptoms found was submitted to a committee of experts to discriminate the most significant signs and symptoms, these were linked to general sociodemographic variables to develop an evaluation questionnaire; Phase 4, the evaluation questionnaire was applied, including those selected signs and symptoms to a group of patients with clinical diagnosis of facet disease lumbar pain and who underwent a selective facet block. Phase 5, under standard technique selective facet block and subsequent postoperative clinical control at 1 month. Phase 6, given pre and postsurgical results associated with signs present in the patients we propose a clinical scale of diagnosis scale. Descriptive statistics and Stata 12.0 were used as statistical software.
A total of 36 signs and symptoms were found for the diagnosis of lumbar facet syndrome that were submitted to the group of experts, where a total of 12 (8 symptoms and 4 signs) were included for the final survey. 31 patients underwent selective lumbar facet blockade, mostly women, with an average of 60±11.5 years, analogous visual scale of preoperative pain of 8/10, postoperative of 1.7/10, the signs and symptoms most frequently found included in a diagnostic scale were: 3 symptoms 1) axial or bilateral axial lumbar pain, 2) improvement with rest, 3) absence of root pattern, may have pseudoradicular pattern, however, the pain is greater lumbar than pain in the leg and 3 clinical signs 1) Kemp sign, 2) pain induced in joint or transverse process, 3) facet stress sign or Acevedo sign.
The clinical diagnosis of lumbar facet pain is still debated. Few diagnostic scales have been postulated, with little or no external validity, so the present study proposes a diagnostic scale consisting of 3 symptoms and 3 clinical signs.
腰痛影响60%至90%的人群。它是成年人致残的常见原因。疼痛可能由不同的解剖结构产生，如小关节。然而，目前小关节产生的疼痛尚无临床诊断方法。因此，本文旨在提出一种腰椎小关节综合征的临床诊断量表。
本研究通过以下6个阶段进行，第1阶段，基于PRISMA清单对小关节源性腰痛的临床诊断进行系统的文献综述；第2阶段，列出用于诊断小关节源性腰痛的体征和症状清单。第3阶段，将所发现的体征和症状清单提交给一个专家委员会，以区分最重要的体征和症状，并将这些体征和症状与一般社会人口统计学变量相关联，以制定一份评估问卷；第4阶段，将评估问卷应用于一组临床诊断为小关节源性腰痛且接受了选择性小关节阻滞的患者，问卷包括那些选定的体征和症状。第5阶段，采用标准技术进行选择性小关节阻滞，并在术后1个月进行临床对照。第6阶段，根据患者术前和术后与存在的体征相关的结果，我们提出了一种临床诊断量表。描述性统计和Stata 12.0被用作统计软件。
共发现36种用于诊断腰椎小关节综合征的体征和症状，并提交给专家小组，最终调查共纳入12种（8种症状和4种体征）。31例患者接受了选择性腰椎小关节阻滞，大多数为女性，平均年龄60±11.5岁，术前疼痛视觉模拟量表平均为8/10，术后为1.7/10，诊断量表中最常出现的体征和症状包括：3种症状，1）轴向或双侧轴向腰痛，2）休息后改善，3）无神经根型表现，可能有假性神经根型表现，然而，腰部疼痛大于腿部疼痛；3种临床体征，1）坎普征，2）关节或横突诱发疼痛，3）小关节应力征或阿塞韦多征。
腰椎小关节疼痛的临床诊断仍存在争议。很少有诊断量表被提出，且外部效度很小或没有，因此本研究提出了一种由3种症状和3种临床体征组成的诊断量表。
