概述

椎管狭窄是指脊柱内部空间狭窄,压迫贯穿脊柱的神经。椎管狭窄最常出现在腰部和颈部。

一些椎管狭窄患者可能无症状。其他患者可能出现疼痛、刺痛、麻木感和肌无力。症状会随时间推移加重。

最常见的椎管狭窄原因是与骨关节炎相关的脊柱磨损性变化。在椎管狭窄重度病例中,医生可能建议通过手术为脊髓或神经创造额外空间。

椎管狭窄的类型

椎管狭窄的类型根据疾病发生于脊柱的部位而确定。可能有多种类型。椎管狭窄的两种主要类型是:

  • 颈椎狭窄。这种类型的椎管狭窄发生在颈部的脊柱部分。
  • 腰椎狭窄。这种状况下,椎管狭窄发生在下背部的脊柱部分。这是最常见的椎管狭窄。

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症状

许多人的 MRI 或 CT 扫描结果上显示患有椎管狭窄,但却没有出现相关症状。如果出现症状,这些症状一般会慢慢显现,随着时间的推移而加重。症状将根据狭窄的位置和受影响的神经而不同。

颈部(颈椎)

  • 手、手臂、脚或腿出现麻木感或刺痛
  • 手、手臂、脚或腿无力
  • 行走和平衡问题
  • 颈部疼痛
  • 在重症病例中出现肠或膀胱功能障碍(尿急和尿失禁)

下背(腰椎)

  • 脚或腿有麻木感或麻刺感
  • 脚或腿无力
  • 当您长时间站立或行走时,单腿或双腿的疼痛或痉挛通常会在您弯腰或坐着时得到缓解
  • 背痛

何时就诊

如果您有所列的任何症状,请就诊。

病因

脊椎(脊柱)从颈部延伸至下背部。脊柱骨形成一个椎管,保护脊髓(神经)。

有些人天生椎管狭窄。但是大多数椎管狭窄是由后天因素导致脊柱内部空间变窄所致。椎管狭窄的原因可能包括:

  • 骨骼过度生长。脊柱骨关节炎相关的磨损会促使形成骨刺,骨刺可能进入椎管。佩吉特病是一种通常会影响成年人的骨病,也可能导致脊柱骨骼过度生长。
  • 椎间盘突出。椎骨之间的软垫具有减震作用,但随着年龄增长会逐渐变干。椎间盘外部裂纹可能会使一些柔软的内部组织逸出并压迫脊髓或神经。
  • 韧带增厚。随着时间的推移,有助于把脊柱骨连接在一起的坚韧组织可能变硬并增厚。这些增厚的韧带可能隆起并进入椎管。
  • 肿瘤。异常生长可发生于脊髓内部、脊髓被膜内或脊髓与椎骨之间的空间中。异常生长并不常见,可通过脊柱 MRI 或计算机断层扫描成像识别。
  • 脊柱损伤。车祸和其他创伤可能导致一块或多块椎骨脱位或骨折。脊柱骨折引起的骨骼移位可能损坏椎管内组织。背部手术后附近组织的肿胀也会压迫脊髓或神经。

风险因素

多数椎管狭窄患者的年龄都在 50 岁以上。尽管退行性病变会导致年龄较小者椎管狭窄,但也要考虑其他因素。这些因素包括创伤、脊柱侧凸等先天性脊柱畸形和影响全身骨骼和肌肉发育的遗传疾病。可以通过脊柱影像学检查鉴别这些病因。

并发症

在极罕见的情况下,未治的重度椎管狭窄可能进展并导致下列永久性问题:

  • 麻木感
  • 虚弱
  • 平衡问题
  • 失禁
  • 瘫痪

在 Mayo Clinic 治疗

July 03, 2022
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