CT in low back pain syndrome

CT has become the imaging modality of choice for diagnosing the specific cause of low back pain syndrome. This article describes and illustrates those abnormalities commonly associated with low back pain: disk herniation, spinal stenoses, facet joint abnormalities, spondylosis, inflammatory conditions of the lumbar spine, and sacroiliitis.     

慢性骨筋膜间隔综合征致下腰痛的临床研究

[目的]探讨慢性骨筋膜间隔综合征所致下腰痛的发病机理。[方法]选取明确诊断为腰骶部慢性骨筋膜间隔综合征且未合并其他腰部疾病的患者30例，分别行腰腹肌肌力测定，竖脊肌内压测定，血常规，血沉，肌酸激酶（CK）及同工酶（CK—MM），乳酸脱氢酶（LDH）及同工酶（LDH，）测定，采用骨筋膜间隔切开减压手术治疗。术中切取竖脊肌标本用于组织病理学观察和透射电镜观察。[结果]各项酶学检验无异常；组织学光镜下观察到竖脊肌纤维部分溶解变性，肌纤维肥大，少量炎性细胞浸润；电镜下观察到肌纤维灶状溶解，核周线粒体聚集，胞内脂滴、溶酶体增多，肌卫星细胞增殖分化。[结论]腰骶部慢性骨筋膜间隔综合征是由于内在压力增加，筋膜间隔内组织代谢障碍，骨骼肌慢性受损，炎症因子释放，最终影响脊神经后支导致的下腰痛。     

Relief of low back pain from treatment of tarsal tunnel syndrome

The authors analyzed 44 patients with low back pain and symptoms of tarsal tunnel syndrome. These patients had proximal radiation of pain to the hip, buttocks, or lower back. Treatment directed to the tarsal tunnel syndrome provided relief for these patients.     

腰背痛流行病学进展

腰背痛患病率高,易复发,大多无明显病因,缺乏特异性表现,具有自愈倾向,仅少数腰背痛患者转为慢性。腰背痛的危险因素有年龄、心理、遗传、性别、职业、妊娠、体重、腰背痛病史、不良生活方式等。腰背痛患病率随年龄增长而增加,但到一定年龄阶段保持不变;社会心理因素对腰背痛的影响渐受重视;性别与腰背痛关系的报道不一;遗传可能是腰背痛最主要的危险因素;某些职业因素如负重、弯腰、旋转、振动等是腰背痛重要的危险因素;近年来与妊娠妇女相关的腰背痛受到重视;生活方式改变可使腰背痛患病率增加。X线和MRI等检查对腰背痛的诊断无特异性,仅适于排除腰背部特异性疾病。腰背痛的治疗方法很多,但流行病学调查显示缺乏有效方法,建议对不同病程采取相应治疗方法。目前腰背痛的预防未能降低发病率。     

Greater trochanter bursitis pain syndrome in females with chronic low back pain and sciatica

Trochanteric bursitis is a clinical condition which simulates major hip diseases and low back pain, it may also mimic nerve root pressure syndrome. Patients with greater trochanteric bursitis pain syndrome (GTBPS) usually suffer from pain radiating to the posterolateral aspect of the thigh, paraesthesiae in the legs, and tenderness over the iliotibial tract.. The purpose of this study is to indicate the similarity between the clinical features of the GTBPS and those of chronic low back pain, and to highlight the importance of diagnosing GTBPS in patients complaining of low back conditions. Three hundred female patients were included in this prospective study. All patients complained about chronic low back pain or sciatica and had a failed long term conservative treatment. Local injection of the tender peritrochanteric area was only done in half of the patients (group 1). Patients were required to answer the Oswestry Disability Index Questionnaire during all periods of follow-up. Patients of group 1 had a better clinical outcome (p < 0.0005) than the patients in group 2 where no injection was done. We conclude that greater trochanter bursitis pain syndrome is a frequent syndrome which may be associated with low back symptoms. Patients with a long standing history of low back pain and sciatica should be routinely checked for GTBPS. GTBPS is easy to diagnose and can be treated. Peritrochanteric infiltration with glucocorticoids mixed with 2% lidocaine relieves patients from their symptoms for a long period of time. Recurrence should always be expected, but treatment may be repeated.     

Diagnostic evaluation of low back pain

The diagnostic evaluation of chronic LBP is at best a complex and involved undertaking. The most important part of the process lies in the knowledge of the patient and a solid history and physical examination. From there, most of the serious and life-threatening causes of LBP can be elucidated and studies may be used for confirmation. Imaging studies are used most practically as confirmation studies once a working diagnosis is determined. MRI, although excellent at defining tumor, infection, and nerve compression, can be too sensitive with regard to degenerative disease findings and commonly displays pathology that is not responsible for the patient's symptoms. As an example, the high-intensity zones (HIZ) seen on MRI are reliable in determining annular defects in the disc but are not reliable in establishing internal disc disruption as the cause of LBP. Discography is the primary tool used by many physicians to determine the true pain generator when discogenic LBP is suspected. Because the reliability of the patient response is fundamental to discography, interpreting the test in different settings must be considered. In individuals with disc degeneration and annular defects, discography may elicit LBP with injection whether the patient is symptomatic with serious LBP or not. The pain response may be amplified in those subjects with issues of chronic pain, social stressors, such as secondary gain or litigation claims, or psychologic distress disorder. These factors have been shown experimentally to be associated with an increased risk for a false positive injection. The ability of an individual to differentiate the true site of LBP by the quality of sensation with disc injection (concordancy) of pain produced by the injected disc also may not be reliable. In fact, individuals may not have the neural discrimination to differentiate sclerotomal pain originating from different sites in the low back and pelvis. One may realize that chronic LBP illness may not stem from a mechanical spinal disorder alone. In fact, the mechanical pathology may be just a portion of the problem with amplification by neurophysiologic, social, and psychologic issues. Chronic disabling LBP commonly is confounded by chronic pain, emotional troubles, poor job satisfaction, alcohol and narcotic abuse, and compensation issues, just to identify a few. It would follow that expecting to identify a single cause for this symptom complex is impractical and any single test may not be a reasonable approach. Furthermore, surgical correction of the mechanical portion of chronic LBP. even if correctly identified, then can be expected only to relieve a portion of a patient's symptoms as long as the confounding issues continue to be significant or have become life long adaptive mechanisms. In the end, the discogram and other diagnostic tests are tools that have clear limitations. In this field, clinical judgment begins and ends with an understanding of a patient's life and circumstances as much as with their specific spinal pathology.     

Foot function and low back pain

The suggestion that foot posture may affect low back pain is one that has received some attention in the literature. This has principally involved theoretical mechanisms that may link the two. This paper reviews each of these mechanisms in turn, and comments upon directions for future research in the area.     

Epidemiology of low back pain.

The science of epidemiology is difficult to apply to the problem of low back pain. This article discusses the problems associated with the study of low back pain, population surveys, risk factors for low back pain, and disability because of low back pain.     

椎间小关节源性腰痛

椎间关节突关节（zygapophysial joint）简称Z关节（Z joint）,又称椎间小关节（facetjoint）。Goldwaith在1911年首先提出腰椎椎间小关节病变是引起腰痛的常见原因。Ghormley在1933年提出“椎间小关节综合征（facet joint syndrome）”的定义,即椎间小关节出现骨关节炎的增生肥大改变,并因此引起的下腰痛和臀部大腿的放射痛心。     

Office management of low back pain

Low back pain, with or without sciatica, is a very common medical problem. Since a great majority of patients can be successfully treated with nonoperative methods, office management of these patients is a very important issue for all clinicians. Patients with low back pain can be divided into three major groups: 1) the first group with acute (initial onset or very occasional recurrent) symptoms, 2) the second group with chronic (frequent intermittent recurrent or persistent) symptoms and 3) the third group with resistant symptoms. For the first group with acute symptoms, establishment of a specific diagnosis is rarely necessary. An active nonoperative treatment program (brief rest, protection, physical therapy modalities, medication, exercises, and reconditioning) provides a high rate (nearly 90 to 95 per cent) of success (return to normal activities and work) within 8 to 12 weeks. For the second group, with chronic symptoms, establishment of a specific diagnosis and a comprehensive and specific history are essential. Diagnostic procedures for specific pathologic conditions are outlined. A clear and specific treatment goal should be established and communicated to all the parties involved. Nonoperative treatment for this group includes back school, postural exercises, bracing, exercises for strength and endurance, work-site modification, vocational counseling, and pain management. For the third group with resistant symptoms, the role of the orthopedic or neurosurgeon is as a consultant to a pain management team for evaluation and treatment of missed diagnosis or complications of previous treatments.