目的:当保守疗法如止痛药或运动疗法失败时,对于腰骶部脊柱疼痛患者,可能需要进行侵入性治疗。荷兰麻醉师学会,与荷兰骨科协会和荷兰神经外科学会合作,已经主动制定了“脊柱下腰痛”的指南,“描述了关于最常见的脊柱下腰痛综合征的诊断和侵入性治疗的证据,也就是说,小关节疼痛,骶髂关节疼痛,尾骨痛,源自椎间盘的疼痛,和失败的背部手术综合征。
方法:本指南的目的是确定在保守治疗失败时,对于每种纳入的疼痛综合征,首选哪种侵入性治疗。使用EBRO标准评估诊断研究,对治疗的研究进行了评估,开发和评估系统。为了评估侵入性治疗方案,指导委员会决定,疼痛的结局指标,函数,生活质量是最重要的。
结果:定义,流行病学,病理生理机制,诊断,报告了每种脊柱背痛综合征的侵入性治疗建议。
结论:指南委员会得出结论,将下腰痛分类为仅特异性或非特异性,对下腰痛问题的认识不足,并且不能充分反映哪种疗法对疼痛综合征的潜在疾病有效。根据指南“脊柱下腰痛,“小关节疼痛,骶髂关节疼痛,椎间盘疼痛将成为计划中的全国成本效益研究的一部分。
OBJECTIVE: When conservative therapies such as pain medication or exercise therapy fail, invasive treatment may be indicated for patients with lumbosacral spinal pain. The Dutch Society of Anesthesiologists, in collaboration with the Dutch Orthopedic Association and the Dutch Neurosurgical Society, has taken the initiative to develop the
guideline \"Spinal low back pain,\" which describes the evidence regarding diagnostics and invasive treatment of the most common spinal low back pain syndromes, that is, facet joint pain, sacroiliac joint pain, coccygodynia, pain originating from the intervertebral disk, and failed back surgery syndrome.
METHODS: The aim of the
guideline is to determine which invasive treatment intervention is preferred for each included pain syndrome when conservative treatment has failed. Diagnostic studies were evaluated using the EBRO criteria, and studies on therapies were evaluated with the Grading of Recommendations Assessment, Development and Evaluation system. For the evaluation of invasive treatment options, the
guideline committee decided that the outcome measures of pain, function, and quality of life were most important.
RESULTS: The definition, epidemiology, pathophysiological mechanism, diagnostics, and recommendations for invasive therapy for each of the spinal back pain syndromes are reported.
CONCLUSIONS: The
guideline committee concluded that the categorization of low back pain into merely specific or nonspecific gives insufficient insight into the low back pain problem and does not adequately reflect which therapy is effective for the underlying disorder of a pain syndrome. Based on the
guideline \"Spinal low back pain,\" facet joint pain, pain of the sacroiliac joint, and disk pain will be part of a planned nationwide cost-effectiveness study.