Wipf J E, Deyo R A
Department of Medicine, University of Washington, Seattle.
Med Clin North Am. 1995 Mar;79(2):231-46. doi: 10.1016/s0025-7125(16)30065-7.
Low back pain is a common reason for physician visits and is associated with enormous costs to health care and industry. Radiographic abnormalities of the lumbar spine, including disk protrusion, are common in asymptomatic subjects and only loosely associated with symptoms and neurologic examination. Therefore, highly selective evaluation is required to avoid subjecting patients with back pain to unnecessary tests and surgical procedures. Reassurance about the favorable prognosis of low back pain is an important component of therapy. Most patients with simple back pain recover with symptomatic treatment. Plain radiographs are indicated for evaluation of patients with radiculopathy and those with risk factors for underlying medical conditions. The majority of patients with back pain, even those with radiculopathy, improve with conservative management and surgery is unnecessary. Surgical consultation and CT or MR imaging scans are indicated for patients with persistent or progressive neurologic deficits or persistent sciatica with nerve root tension signs. Acute radiculopathy with bilateral neurologic deficits, saddle anesthesia, or urinary symptoms is suggestive of cord compression or cauda equina syndrome and requires urgent surgical referral.
下腰痛是患者就医的常见原因，给医疗保健和产业带来了巨大成本。腰椎的影像学异常，包括椎间盘突出，在无症状人群中很常见，且与症状及神经学检查仅有松散关联。因此，需要进行高度选择性评估，以避免让背痛患者接受不必要的检查和外科手术。让患者放心下腰痛预后良好是治疗的重要组成部分。大多数单纯背痛患者通过对症治疗即可康复。对于患有神经根病的患者以及有潜在疾病危险因素的患者，需进行X线平片检查以评估病情。大多数背痛患者，即使是患有神经根病的患者，通过保守治疗即可改善，无需进行手术。对于有持续或进行性神经功能缺损的患者，或有持续坐骨神经痛及神经根张力体征的患者，需进行外科会诊并进行CT或磁共振成像扫描。伴有双侧神经功能缺损、鞍区感觉缺失或泌尿系统症状的急性神经根病提示脊髓受压或马尾综合征，需要紧急转诊至外科。
