Farley Tyler, Stokke Jesse, Goyal Kush, DeMicco Russell
Center for Spine Health, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
Life (Basel). 2024 Jun 27;14(7):812. doi: 10.3390/life14070812.
Chronic low back pain (cLBP) is the most frequently reported cause of years lived with disability. Identifying the anatomical structures or dysfunction contributing to patients' symptoms is critical to guiding treatment. The etiology of back pain and differential diagnosis is often broad, ranging from non-degenerative cLBP (trauma, tumor, inflammation, infection, etc.) to degenerative (also described as nonspecific) cLBP. After eliminating suspicion for more insidious causes of cLBP, a thorough investigation can be conducted in an attempt to identify a source of degenerative cLBP. Degenerative cLBP can originate from many sources, and a detailed understanding of the structures potentially involved is invaluable for an accurate diagnosis. This review article aims to provide a broad overview of the utility of clinical history, physical exam findings, imaging findings, and diagnostic procedures in identifying the cause of patients' cLBP. We provide a framework to help guide clinicians by dividing the structures into groups as follows: anterior vertebral column, posterior vertebral column, and extra-vertebral pain. For each condition listed, we touch on the treatment options that can be considered.
慢性下腰痛（cLBP）是导致残疾生存年数的最常见原因。确定导致患者症状的解剖结构或功能障碍对于指导治疗至关重要。背痛的病因和鉴别诊断通常范围广泛，从非退行性cLBP（创伤、肿瘤、炎症、感染等）到退行性（也称为非特异性）cLBP。在排除对cLBP更隐匿病因的怀疑后，可以进行全面调查，以试图确定退行性cLBP的来源。退行性cLBP可源于多种原因，对潜在涉及的结构有详细了解对于准确诊断非常重要。这篇综述文章旨在全面概述临床病史、体格检查结果、影像学检查结果和诊断程序在确定患者cLBP病因方面的作用。我们提供一个框架，通过将结构分为以下几组来帮助指导临床医生：前柱、后柱和椎外疼痛。对于列出的每种情况，我们会提及可考虑的治疗选择。
