腰椎间盘退变性疾病
腰椎间盘退变性疾病患者指南
引论
The intervertebral discs in the lower spine are commonly blamed for low back pain. Yet low back pain has many possible causes, and doctors aren’t always certain why symptoms occur.
尽管腰痛是由多种原因引起的，而且有时候医生往往找不到腰痛发生的具体原因，但腰痛发生时椎间盘往往首当其冲被认为是导致腰痛的原因。
During an office visit for low back pain, your doctor may describe how changes in the discs can lead to back pain. When talking about these changes, your doctor may use the terms degeneration or degenerative disc disease.
由于腰痛去门诊看病时，你的医生往往会描述椎间盘是如何改变从而导致腰痛，当他们谈到这些改变的时候他们往往会用到一些象“椎间盘退变性疾病”这样的术语。
Although the parts of the spine do change with time and in some sense degenerate, this does not mean the spine is deteriorating and that you are headed for future pain and problems. These terms are simply a starting point for describing what occurs in the spine over time, and how the changes may explain the symptoms people feel.
尽管随着时间的变化，椎间盘会发生一些退变，但这些退变并不意味着脊柱功能的恶化或者未来将会发生疼痛或病变。这些术语只是简单描述在这段时间内脊柱所发生的变化的切入点，并用来解释这些变化是如何引起相关的症状。
This guide will help you understand
这个指南将更好的帮助你理解：
how degenerative disc disease develops
how doctors diagnose the condition
what treatment options are available
椎间盘退变性疾病是如何发展的
医生是如何诊断这种病
如何选择治疗
解剖
What parts of the spine are involved?
脊柱哪一部分受累？
The human spine is made up of 24 spinal bones, called vertebrae. Vertebrae are stacked on top of one another to form the spinal column. The spinal column gives the body its form. It is the body’s main upright support. The section of the spine in the lower back is known as the lumbar spine.
人类脊柱由24个椎体组成，24个椎体从上至下逐一排列构成了脊柱，而脊柱则是人体躯干的主要骨骼结构，起到了支撑的作用。脊柱在人体背部下部分的那一个区域被称为腰椎。
An intervertebral disc sits between each pair of vertebrae. The intervertebral disc is made of connective tissue. Connective tissue is the material that holds the living cells of the body together. Most connective tissue is made of fibers of a material called collagen. These fibers help the disc withstand tension and pressure.
椎间盘位于相邻两个椎体之间，由结缔组织构成。结缔组织是将人体活的细胞维持在一起的材料，大多由称为胶原的纤维原料构成。椎间盘中的胶原纤维使椎间盘能够抵抗张力和压力。
The disc normally works like a shock absorber. It protects the spine against the daily pull of gravity. It also protects the spine during strenuous activities that put strong force on the spine, such as jumping, running, and lifting.
正常的椎间盘在人体日常活动中可以克服重力所带来的冲击，主要起到一个“减震”的作用，同时它还可以防止在我们从事剧烈活动例如跑步、跳跃、举重的时候脊柱过度拉伸。
An intervertebral disc is made of two parts. The center, called the nucleus, is spongy providing most of the disc’s ability to absorb shock. It is held in place by the annulus, a series of strong ligament rings surrounding it. Ligaments are connective tissues that attach bones to other bones.
椎间盘由两个部分组成：髓核，位于椎间盘中央主要发挥吸收冲击力的作用（减震）。纤维环包绕在髓核周围，它是一些坚韧的韧带组织将髓核维系在椎间盘中央。韧带是连接骨与骨之间的结缔组织。
Between the vertebrae of each spinal segment are two facet joints. The facet joints are located on the back of the spinal column. There are two facet joints between each pair of vertebrae, one on each side of the spine. A facet joint is made of small, bony knobs that line up along the back of the spine. Where these knobs meet, they form a joint that connects the two vertebrae. The alignment of the facet joints of the lumbar spine allows freedom of movement as you bend forward and back.
在每个脊柱节段之间是两个关节突关节，它位于脊柱的后方。每对椎体之间均有两个关节突关节，脊柱两侧各有一个。关节突关节由小的骨性突起构成，位于脊柱的后方。这些骨性突起相接触之处，形成了连接两个椎体的关节。腰椎的关节突关节使我们可以自由地做腰部屈伸活动。
Related Document: A Patient’s Guide to Lumbar Spine Anatomy
相关阅读：腰椎解剖患者指南（翻译招募中，有兴趣者请留言）
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原因
Why do I have this problem?
为什么我们会患腰椎间盘退变性疾病呢？
Our intervertebral discs change with age, much like our hair turns gray. Conditions such as a major back injury or fracture can affect how the spine works, making the changes happen even faster.
就像我们头发会变白，椎间盘也会随着我们的年纪改变，一些大的创伤例如腰部损伤或者是腰椎骨折都会加速这个改变。
Daily wear and tear and certain types of vibration can also speed up degeneration in the spine. In addition, strong evidence suggests that smoking speeds up degeneration of the spine. Scientists have also found links among family members, showing that genetics play a role in how fast these changes occur.
日常的磨损和撕裂以及某些特定震动都会加速脊柱退变。另外，还有非常充分的证据显示吸烟会加快椎间盘的退变。科学家们还发现家庭成员之间相关性，显示椎间盘的退变还受遗传的影响。
Disc degeneration follows a predictable pattern. First, the nucleus in the center of the disc begins to lose its ability to absorb water. The disc becomes dehydrated. Then the nucleus becomes thick and fibrous, so that it looks much the same as the annulus. As a result, the nucleus isn’t able to absorb shock as well. Routine stress and strain begin to take a toll on the structures of the spine. Tears form around the annulus. The disc weakens. It starts to collapse, and the bones of the spine compress.
椎间盘的退变往往有其固定的模式：首先，髓核逐渐丧失吸水的能力，椎间盘处于脱水状态；然后髓核逐渐变薄并且纤维化，看上去就像纤维环。最终髓核丧失减震的能力，日常的压力和扭力就会损伤脊柱的结构，纤维环周边撕裂，椎间盘衰退并开始塌陷，脊椎骨受压。
View animation of degeneration骨科小病不求医049：腰椎间盘退变性疾病（Lumbar Degenerative Disc Disease）
Related Document: A Patient’s Guide to Low Back Pain
相关阅读：腰痛患者指南
This degeneration does not always mean the disc becomes a source of pain. In fact, X-rays and MRI scans show that people with severe disc degeneration don’t always feel pain.
但是这种退变并不能和腰痛联系在一起，事实上，很多在X线和磁共振检查中发现有明显椎间盘退变的并没有伴随的着腰痛的发生。
Pain caused by degenerative disc disease is mainly mechanical pain, meaning it comes from the parts of the spine that move during activity: the discs, ligaments, and facet joints. Movement within the weakened structures of the spine causes them to become irritated and painful.
由退变性腰椎间盘疾病引起的疼痛往往是机械性疼痛。也就是说是因为椎间盘、韧带、关节突关节等脊柱结构活动时引起的。当脊柱的这些结构退变后，活动时就会刺激它们并引起疼痛。
症状
What does the condition feel like?
腰椎间盘退变性疾病的疼痛特点
Pain in the center of the low back is often the first symptom patients feel. It usually starts to affect patients in their twenties and thirties. Pain tends to worsen after heavy physical activity or staying in one posture for a long time. The back may also begin to feel stiff. Resting the back eases pain. At first, symptoms only last a few days.
疼痛往往先发生在腰部中心，往往在患者二十几或者三十几岁时就出现，并在重体力劳动、高强度运动或者长时间维持一个姿势后加重。患者往往感觉自己的背部很僵硬，休息后疼痛会改善。在初期，这个症状往往会持续几天。
This type of back pain often comes and goes over the years. Doctors call this recurring back pain. Each time it strikes, the pain may seem worse than the time before. Eventually the pain may spread into the buttocks or thighs, and it may take longer for the pain to subside.
这种疼痛往往会在几年间反复发生，医生们称之为复发性腰痛。每次疼痛发生往往都会比上一次严重，最终疼痛会延伸到臀部和大腿，并需要更长时间来缓解。
诊断
How do doctors diagnose the problem?
医生是如何来诊断这个疾病的？
Diagnosis begins with a complete history and physical exam. Your doctor will ask questions about your symptoms and how your problem is affecting your daily activities. Your doctor will also want to know what positions or activities make your symptoms worse or better.
医师往往会根据患者完整的病史和体格检查做出诊断。医生将会问你一些关于你所有的症状和这些症状如何影响你生活的问题。医生也会了解哪些体位或者活动会加重或者减轻你的症状。
Then the doctor does a physical examination by checking your posture and the amount of movement in your low back. Your doctor checks to see which back movements cause pain or other symptoms. Your skin sensation, muscle strength, and reflexes are also tested.
然后医生将会检查你的姿势和腰部的活动度，从而观察怎样的的活动和姿势会引起你的疼痛。医生还会检查你的皮肤感觉、肌肉力量以及腱反射。
Doctors rely on the history and physical exam to determine which treatments will help the most. X-rays are rarely ordered on the first doctor visit for this problem. This is because over 30 percent of low back X-rays show abnormalities from degeneration, even in people who aren’t having symptoms.
根据对患者的体格检查，医生们往往就可以给出相关治疗的办法，很少有医生在患者第一次来门诊时就给予X线的检查。因为30%的腰椎X线片显示有退变引起的异常，甚至在没有症状的人群。
However, if symptoms are severe and aren’t going away, the doctor may order an X-ray. The test can show if one or more discs has started to collapse. It can also show if there are bone spurs in the vertebrae and facet joints. Bone spurs are small points of bone that form with degeneration.
但是如果症状持续恶化，医生会给予X线的检查，从而可以知道是否存在一个或者多个椎间盘发生结构上的严重破坏。X线还可以发现由退变导致的椎体和关节突关节的骨赘。骨赘是因退变而形成的骨的小突起。
When more information is needed, your doctor may order a magnetic resonance imaging (MRI) scan. The MRI machine uses magnetic waves rather than X-rays to show the soft tissues of the body. It is helpful for showing if the tissues in the disc are able to absorb water and whether there are cracks inside the disc. It can also show if there are problems in other soft tissues, such as the spinal nerves.
如果还需要知道更多信息，医生会再给患者做一个磁共振的检查，磁共振机器使用磁力波而不是X线来显示人体的软组织，有助于显示椎间盘组织的吸水能力以及一些椎间盘内部结构的裂隙。磁共振检查还可以显示其他一些软组织如脊神经等的病变。
Discography can help with the diagnosis. This is a specialized X-ray test in which dye is injected into one or more discs. The dye is seen on X-ray and can give some information about the health of the disc or discs. This test may be done when the surgeon is considering surgery, since it can help determine which disc is causing the symptoms.
椎间盘造影是一种特殊的X线检查，它通过往一个或多个椎间盘内注射造影剂来显示椎间盘的健康信息，从而用来诊断疾病。这种检查往往是脊柱外科医师决定做手术时去做，用来判断引起相关症状的责任节段。
（夏冬冬 译）
夏冬冬，同济大学附属上海东方医院 脊柱外科博士，美国布莱根妇女医院/哈佛大学医学院博士后，国际FOP（进行性骨化症）协会科研项目负责人。
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