椎间盘源性下腰痛诊断-英文-翻译1

盘源性下腰痛的鉴别诊断

With so many possible causes of lower back pain, physicians must pinpoint the source(s) of pain to recommend appropriate action or no action. The IDET procedure is not suitable for every form of lower back pain. Chronic discogenic lower back pain unresponsive to aggressive non-operative therapy is the principal indication for the IDET procedure.

IDET不是适合于任何下腰痛患者。盘源性下腰痛才是IDET的手术指征。

∙Differential diagnosis starts with a detailed history, physical examination and an MRI.

鉴别诊断要从相信的病史、体检及MRI检查开始。

∙Non-musculoskeletal causes of back pain such as tumor, infection, aneurysm and renal and vascular pathology should be considered and ruled out.

排除非肌肉骨骼原因引起的下腰痛，如：肿瘤、感染、动脉瘤、肾脏疾病等，都需要被考虑到并排除。

∙Fractures and ankylosing spondylitis should also be ruled out.

排除骨折及强直性脊柱炎。

∙Discogenic pain should be differentiated from radicular pain, which may also be present.

还需与神经根痛相鉴别。

盘源痛与神经根痛的比较

∙

∙

∙

∙

∙

∙

∙

∙

∙

∙

∙

∙

∙

∙

∙Pain which is unilateral and predominantly below lumbar vertebra 5 is probably not discogenic. 单侧疼痛而且疼痛点低于腰5的情况下大多不是盘源性的。

∙Diagnostic joint blocks can be used to trace the source of pain, which can be attributed to the sacroiliac joint in about 20% of patients and lumbar zygapophysial joint pain in up to 40% of patients.

压痛点有助于医师发现疼痛的根源，大约20%的病人压痛点在骶髂关节，而40%以上的患者压痛点在腰椎小关节处。

∙Patients with discogenic pain may have no abnormalities visible on the MRI or may have a bright spot in the posterior anulus referred to as the high intensity zone or HIZ. This is best seen on sagittal views and indicates a tear in the disc.

大多数盘源性疼痛患者MRI图像没有明显的异常。或在纤维环后方有高强度区域。这种情况在矢状面时比较容易看到。常表明椎间盘有微小的裂纹。

椎间盘源性痛可以通过椎间盘造影刺激并重建症状。

Discography is a minimally invasive diagnostic procedure performed while the subject is awake. Sedation and analgesia can be provided to minimize discomfort. Contrast medium is injected into the three or four discs under investigation as the source of the low back pain.

椎间盘造影是一种微创的复制患者症状的检查方法。操作中可适当给以镇静止痛药物以减轻患者不安，将对比造影剂注射入3-4个椎间盘内以确定疼痛源。

∙The injection of fluid into each disc increases the fluid volume and pressure in the disc and may reproduce the subject’s usual pain pattern.

将造影剂注射入每个椎间盘内可以增加椎间盘内液体体积及压力可以重建患者的疼痛症状。

∙ A positive response in one disc confirmed by the absence of a pain response in one or more other adjacent discs confirms the origin of the pain.

椎间盘内注射出现的阳性反应与患者疼痛区域相同可以证实某个椎间盘为症状根源。

∙In addition, the contrast medium allows the morphology of the disc to be visualized fluoroscopically.

另外，造影剂可以通过透视显示椎间盘的形状。

Since provocation discography is minimally invasive and produces some discomfort, it should only be performed when a definitive diagnosis will lead to treatment that would otherwise not be performed.

尽管椎间盘造影是微创过程仅有较少不适，但这一检查方式仅应在为确定诊断或确定手术部位时才能使用。

确定疼痛源

The disc which is the source of the low back pain can be confirmed when: