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首页> 美国卫生研究院文献>European Spine Journal >Systematic review of tests to identify the disc SIJ or facet joint as the source of low back pain
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Systematic review of tests to identify the disc SIJ or facet joint as the source of low back pain

机译：系统检查以鉴定椎间盘SIJ或小关节为下腰痛的原因的检查方法

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Clinical practice guidelines state that the tissue source of low back pain cannot be specified in the majority of patients. However, there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain. The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc, facet joint or sacroiliac joint (SIJ) as the source of low back pain. MEDLINE, EMBASE and CINAHL were searched up to February 2006 with citation tracking of eligible studies. Eligible studies compared index tests with an appropriate reference test (discography, facet joint or SIJ blocks or medial branch blocks) in patients with low back pain. Positive likelihood ratios (+LR) > 2 or negative likelihood ratios (-LR) < 0.5 were considered informative. Forty-one studies of moderate quality were included; 28 investigated the disc, 8 the facet joint and 7 the SIJ. Various features observed on MRI (high intensity zone, endplate changes and disc degeneration) produced informative +LR (> 2) in the majority of studies increasing the probability of the disc being the low back pain source. However, heterogeneity of the data prevented pooling. +LR ranged from 1.5 to 5.9, 1.6 to 4.0, and 0.6 to 5.9 for high intensity zone, disc degeneration and endplate changes, respectively. Centralisation was the only clinical feature found to increase the likelihood of the disc as the source of pain: +LR = 2.8 (95%CI 1.4–5.3). Absence of degeneration on MRI was the only test found to reduce the likelihood of the disc as the source of pain: −LR = 0.21 (95%CI 0.12–0.35). While single manual tests of the SIJ were uninformative, their use in combination was informative with +LR of 3.2 (95%CI 2.3–4.4) and −LR of 0.29 (95%CI 0.12–0.35). None of the tests for facet joint pain were found to be informative. The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ (but not the facet joint) as the source of low back pain. However, the changes in probability are usually small and at best moderate. The usefulness of these tests in clinical practice, particularly for guiding treatment selection, remains unclear.Electronic supplementary materialThe online version of this article (doi:10.1007/s00586-007-0391-1) contains supplementary material, which is available to authorized users.
机译：临床实践指南指出，大多数患者无法确定下腰痛的组织来源。但是，对于用于确定下腰痛来源的诊断测试的准确性尚未进行系统的审查。因此，本系统综述的目的是确定临床医生可用来鉴定椎间盘，小关节或sa关节（SIJ）为下腰痛来源的测试的诊断准确性。截至2006年2月，对MEDLINE，EMBASE和CINAHL进行了检索，并对符合条件的研究进行了引文跟踪。符合条件的研究将下腰痛患者的指数测试与适当的参考测试（椎间盘造影，小关节或SIJ阻滞或内侧分支阻滞）进行了比较。正似然比（+ LR）> 2或负似然比（-LR）<0.5被认为是信息性的。包括四十一项中等质量的研究。 28个调查了椎间盘，8个小关节和7个SIJ。在大多数研究中，MRI观察到的各种特征（高强度区，终板变化和椎间盘退变）产生了有益的+ LR（> 2），增加了椎间盘成为下腰痛源的可能性。但是，数据的异质性阻止了合并。对于高强度区域，椎间盘退变和终板改变，+ LR的范围分别为1.5至5.9、1.6至4.0和0.6至5.9。集中化是发现增加椎间盘作为疼痛源的可能性的唯一临床特征：+ LR = 2.8（95％CI 1.4–5.3）。唯一没有发现MRI变性的测试可降低椎间盘作为疼痛源的可能性：−LR = 0.21（95％CI 0.12-0.35）。尽管对SIJ进行的单次手动测试没有提供信息，但结合使用时，其+ LR为3.2（95％CI 2.3-4.4）和-LR为0.29（95％CI 0.12-0.35）。没有发现小关节疼痛的测试可以提供信息。这篇综述的结果表明确实存在改变椎间盘或SIJ（但无小关节）作为下腰痛来源的可能性的测试。但是，概率的变化通常很小，最好是中等的。这些测试在临床实践中是否有用，尤其是在指导治疗选择方面尚不清楚。电子补充材料本文的在线版本（doi：10.1007 / s00586-007-0391-1）包含补充材料，授权用户可以使用。

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