下背痛來源與危險因子新焦點之相關探討回顧

下背痛是人類非常普遍的疾患，經常造成家庭、社會、國家的重大之負擔與影響。大部分的下背痛病患很難有明確的解剖學或組織學上的診斷，了解下背痛的實際來源必須依照實證醫學觀念，以客觀準則來審視下背痛來源，確實審視相關證據，確認相關組織結構是否有可能是背痛的原因和來源，最近文獻提出神經組織增生分佈到椎間盤深層組織甚至髓核部位以及在傷害之椎間盤中發現微生物之寄生，提供我們未來對於下背痛之診斷和治療方面一個參考的方向。就危險因子而言，基因的影響與青少年時期罹患下背痛，相信對日後下背痛防治之策略、方法，將有不同的思考方式，必須在我們既有的方式中，審慎地考量基因的影響作用，並且及早對青少年的介入，找出真正治本之道。

關鍵字

下背痛；診斷；危險因子

並列摘要

Low back pain (LBP) is a common disorder in human, and always has a big impact on the back pain persons, their family, society, and nation. It is difficult to make either anatomical or histological diagnosis in most LBP cases. New evidences which include the nerves innervated into deeper layers of the disc, and microorganisms found in the disc provide us the new concepts in LBP diagnosis. Some special genes associated to LBP were found as significant risk factors. Evidences also show that LBP is a serious problem since childhood. This review brings us new evidences in the sources of LBP and its risk factors. Since prevention is the best policy when dealing with LBP, we have to reform the way we treat and prevent LBP. Disc with ingrowing nerve and microorganisms should be considered in treatment. Specific prevention program should be offered for those persons who carry the LBP-related genes and LBP prevention programs should be started in childhood as early as possible.