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颈部和背部疼痛鉴别诊断的快速综合指南:叙述性综述

A Quick and Comprehensive Guide to Differential Diagnosis of Neck and Back Pain: a Narrative Review.

作者信息

Krasin Elisha, Schermann Haggai, Snir Nimrod, Tudor Adrian, Behrbalk Eyal

机构信息

Division of Orthopedic Surgery at Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Department of Orthopedic Surgery at Hillel Yaffe Medical Center, Hadera, Israel, affiliated with the Rappaport Faculty of Medicine, Technion, Haifa, Israel.

出版信息

SN Compr Clin Med. 2022;4(1):232. doi: 10.1007/s42399-022-01321-y. Epub 2022 Oct 27.

DOI:10.1007/s42399-022-01321-y
PMID:36320816
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9610337/
Abstract

The list of diagnostic options when approaching a patient with axial pain is impressively complex. Many offer limited diagnostic workups, but we could not find a truly comprehensive diagnostic guide to assist in the diagnostic evaluation. In this short paper, we briefly described a long list of medical conditions, each of which can manifest as back or neck pain, and whose prevalence ranges from common to very rare. We then proposed an algorithm for classifying them into subgroups. Further referral to diagnostic tests and specialist consultations, after assignment to one of those subgroups, could save time and unnecessary tests. We believe that this review and the proposed diagnostic algorithm can be valuable for medical education and for use in the primary care setting for the diagnostic evaluation of any type of back or neck pain in all patient groups.

摘要

在接诊有轴向疼痛的患者时,诊断选项的清单复杂得令人印象深刻。许多检查提供的诊断方法有限,但我们找不到一份真正全面的诊断指南来协助进行诊断评估。在这篇短文中,我们简要描述了一长串疾病,其中每一种都可能表现为背部或颈部疼痛,其患病率从常见到非常罕见不等。然后,我们提出了一种将它们分类为亚组的算法。在将患者分配到其中一个亚组后,进一步转诊进行诊断测试和专科会诊,可以节省时间和避免不必要的检查。我们相信,这篇综述和提出的诊断算法对于医学教育以及在初级保健环境中对所有患者群体的任何类型的背部或颈部疼痛进行诊断评估都可能是有价值的。

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N Engl J Med. 2020 Jul 9;383(2):159-168. doi: 10.1056/NEJMra2003558.
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COVID-19 diagnosis and management: a comprehensive review.COVID-19 的诊断与管理:全面综述。
J Intern Med. 2020 Aug;288(2):192-206. doi: 10.1111/joim.13091. Epub 2020 May 13.
4
Low Back Pain in the Emergency Department: Prevalence of Serious Spinal Pathologies and Diagnostic Accuracy of Red Flags.急诊科的下背痛:严重脊柱病变的患病率和危险信号的诊断准确性。
Am J Med. 2020 Jan;133(1):60-72.e14. doi: 10.1016/j.amjmed.2019.06.005. Epub 2019 Jul 3.
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Modic I changes size increase from supine to standing MRI correlates with increase in pain intensity in standing position: uncovering the "biomechanical stress" and "active discopathy" theories in low back pain.MRI 矢状面测量 Modic I 型改变的大小在站立位时比仰卧位时增加,与站立位疼痛加重相关:揭示腰痛的“生物力学应激”和“活跃性椎间盘病”理论。
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Imaging of Vascular Disorders of the Spine.脊柱血管疾病的影像学检查
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Diffuse Idiopathic Skeletal Hyperostosis, Associated Morbidity, and Healthcare Utilization: A University Hospital Experience.弥漫性特发性骨肥厚症的相关发病情况、合并症及医疗保健利用:大学附属医院的经验。
J Clin Rheumatol. 2020 Apr;26(3):104-108. doi: 10.1097/RHU.0000000000000965.
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