Fritz J M, Delitto A, Welch W C, Erhard R E
Comprehensive Spine Center, University of Pittsburgh Medical Center, University of Pittsburgh, PA, USA.
Arch Phys Med Rehabil. 1998 Jun;79(6):700-8. doi: 10.1016/s0003-9993(98)90048-x.
The purpose of this review is to present current information from the literature regarding the pathoanatomy, clinical presentation, differential diagnosis, treatment, and outcome assessment methods for patients with lumbar spinal stenosis. Lumbar spinal stenosis is a frequently encountered condition, particularly in the elderly. Treatment requires an accurate diagnosis, but differential diagnosis of lumbar stenosis can be difficult. The literature to date has focused primarily on surgical treatment. The long-term efficacy of surgery has been questioned, and surgical procedures are associated with increased costs and risks of morbidity in an elderly population. A trial of conservative care is recommended in most cases, but there are presently no randomized controlled studies in the literature comparing surgical versus conservative management, or evaluating the effectiveness of any specific conservative treatment approach. The existing literature has further been criticized for having poorly defined outcome measures. The assessment of treatment outcomes should be multifactorial, including measures of pathoanatomy and impairments, as well as patient-centered measures such as level of disability, patient expectations, and satisfaction. The present level of understanding of lumbar spinal stenosis is deficient in many areas, including differential diagnosis, treatment, and outcome assessment. Future research should address these deficits to improve the management of patients with this condition.
本综述的目的是呈现来自文献的关于腰椎管狭窄症患者的病理解剖、临床表现、鉴别诊断、治疗及疗效评估方法的当前信息。腰椎管狭窄症是一种常见病症，尤其是在老年人中。治疗需要准确的诊断，但腰椎管狭窄症的鉴别诊断可能具有挑战性。迄今为止的文献主要聚焦于手术治疗。手术的长期疗效受到质疑，并且手术操作在老年人群中会增加成本及发病风险。在大多数情况下推荐进行保守治疗试验，但目前文献中尚无比较手术与保守治疗管理或评估任何特定保守治疗方法有效性的随机对照研究。现有文献还因结局指标定义不明确而受到批评。治疗结局的评估应是多因素的，包括病理解剖和功能障碍的指标，以及以患者为中心的指标，如残疾程度、患者期望和满意度。目前对腰椎管狭窄症的理解在许多方面存在不足，包括鉴别诊断、治疗和疗效评估。未来的研究应解决这些不足，以改善对此类患者的管理。
