An H S, Haughton V M
Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee.
Semin Ultrasound CT MR. 1993 Dec;14(6):414-24. doi: 10.1016/s0887-2171(05)80035-6.
This article reviews the differential diagnosis of lumbar radiculopathy, clinical presentations of spinal stenosis, pathological anatomy, and roentgenographic considerations of lumbar spinal stenosis. Most patients suspected of symptomatic spinal stenosis should have plain roentgenograms first to rule out other obvious lesions and to evaluate disc space and foraminal narrowing. Plain roentgenograms also show the sagittal and coronal deformities if present. The next procedure for the evaluation of spinal stenosis after plain roentgenograms should be MRI, as myelogram or CT can be avoided in most cases. In select cases, patients who cannot get MRI or those who underwent MRI with unresolved questions should have a myelogram or CT for further evaluation.
本文回顾了腰椎神经根病的鉴别诊断、椎管狭窄的临床表现、病理解剖以及腰椎椎管狭窄的影像学检查要点。大多数疑似有症状性椎管狭窄的患者应首先进行普通X线检查，以排除其他明显病变，并评估椎间隙和椎间孔狭窄情况。普通X线检查还可显示矢状面和冠状面畸形（如有）。普通X线检查后评估椎管狭窄的下一步检查应是磁共振成像（MRI），因为在大多数情况下可避免脊髓造影或计算机断层扫描（CT）。在某些特定病例中，无法进行MRI检查的患者或MRI检查后仍有疑问的患者应进行脊髓造影或CT检查以进一步评估。
