Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk/Lanaken, Belgium.
Pain Medicine Division, Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Pain Pract. 2024 Mar;24(3):525-552. doi: 10.1111/papr.13317. Epub 2023 Nov 20.
INTRODUCTION: Patients suffering lumbosacral radicular pain report radiating pain in one or more lumbar or sacral dermatomes. In the general population, low back pain with leg pain extending below the knee has an annual prevalence that varies from 9.9% to 25%. METHODS: The literature on the diagnosis and treatment of lumbosacral radicular pain was reviewed and summarized. RESULTS: Although a patient's history, the pain distribution pattern, and clinical examination may yield a presumptive diagnosis of lumbosacral radicular pain, additional clinical tests may be required. Medical imaging studies can demonstrate or exclude specific underlying pathologies and identify nerve root irritation, while selective diagnostic nerve root blocks can be used to confirm the affected level(s). In subacute lumbosacral radicular pain, transforaminal corticosteroid administration provides short-term pain relief and improves mobility. In chronic lumbosacral radicular pain, pulsed radiofrequency (PRF) treatment adjacent to the spinal ganglion (DRG) can provide pain relief for a longer period in well-selected patients. In cases of refractory pain, epidural adhesiolysis and spinal cord stimulation can be considered in experienced centers. CONCLUSIONS: The diagnosis of lumbosacral radicular pain is based on a combination of history, clinical examination, and additional investigations. Epidural steroids can be considered for subacute lumbosacral radicular pain. In chronic lumbosacral radicular pain, PRF adjacent to the DRG is recommended. SCS and epidural adhesiolysis can be considered for cases of refractory pain in specialized centers.
简介:患有腰骶神经根痛的患者会报告在一个或多个腰或骶部皮节出现放射痛。在普通人群中,腰痛伴疼痛延伸至膝以下的患者的年患病率为 9.9%至 25%不等。
方法:回顾并总结了腰骶神经根痛的诊断和治疗相关文献。
结果:尽管患者的病史、疼痛分布模式和临床检查可能提示腰骶神经根痛的诊断,但可能需要额外的临床检查。医学影像学研究可以显示或排除特定的潜在病理,并确定神经根刺激,而选择性诊断性神经根阻滞可用于确认受累的水平。在亚急性腰骶神经根痛中,经椎间孔皮质类固醇注射可提供短期疼痛缓解和改善活动度。在慢性腰骶神经根痛中,脉冲射频(PRF)治疗靠近脊神经根节(DRG)可在选择合适的患者中提供更长时间的疼痛缓解。对于难治性疼痛,可以考虑在有经验的中心进行硬膜外松解和脊髓刺激。
结论:腰骶神经根痛的诊断基于病史、临床检查和其他检查的综合结果。对于亚急性腰骶神经根痛,可以考虑硬膜外皮质类固醇注射。对于慢性腰骶神经根痛,建议采用靠近 DRG 的 PRF。对于特定中心的难治性疼痛,可以考虑 SCS 和硬膜外松解。
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