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Facetteninfiltration und periradikuläre Therapie

Facet infiltration and periradicular therapy

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Zusammenfassung

Hintergrund

Beschwerden im Bereich der Wirbelsäule betreffen einen großen Teil der Bevölkerung und führen zu zahlreichen Arztbesuchen.

Fragestellung

Verschiedene Techniken der CT-gesteuerten Infiltration bei Wirbelsäulenbeschwerden unter Berücksichtigung der Facetteninfiltration, der periradikulären Infiltration sowie der epiduralen Umflutung werden dargestellt.

Material und Methodik

Grundlagenarbeiten und Expertenempfehlungen werden diskutiert sowie verschiedene Behandlungsschritte für den klinischen Alltag dargestellt.

Ergebnisse

Die CT-gesteuerte Anwendung der verschiedenen Infiltrationsarten ermöglicht eine präzise Durchführung der Therapie. Sowohl die Facetteninfiltration als auch die periradikuläre Infiltration und die epidurale Umflutung haben in Abhängigkeit von der klinischen Symptomatik ihren Stellenwert. Die optimale Kombination der zu applizierenden der Medikamente ist immer noch Gegenstand zahlreicher Studien und zum Teil kontroverser Diskussionen.

Schlussfolgerung

Eine exakte klinische und bildgebende Evaluation der Schmerzsymptomatik im Bereich des Rückens ist die Grundvoraussetzung für eine zielgerichtete Therapie.

Abstract

Background

Spinal complaints affect a large proportion of the population and lead to numerous doctor visits.

Purpose

The different techniques of CT-guided infiltration of spinal disorders, taking into account facet infiltration, periradicular infiltration and epidural flooding are demonstrated.

Materials and methods

Discussion of basic work and expert recommendations as well as presentation of different treatment steps for everyday clinical practice.

Results

The CT-guided application of the different types of infiltration allows precise execution of the therapy. Both facet infiltration and periradicular infiltration and epidural flooding have their place depending on the clinical symptoms. The optimal combination of drugs to administer is still the subject of numerous studies and sometimes controversial discussions.

Conclusion

An exact clinical and imaging evaluation of the pain symptoms in the back is the basic requirement for a targeted therapy

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Literatur

  1. Abdi S, Datta S, Trescot AM, Schultz DM, Adlaka R, Atluri SL et al (2007) Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician 10(1):185–212

    PubMed  Google Scholar 

  2. Ariche K, Goldstein L (2015) Lumbar facet joint injections: Is CT guided intra-articular needle position advantageous? J Pain Relief. https://doi.org/10.4172/2167-0846.1000178

    Article  Google Scholar 

  3. Doğan A, Doğan K, Taşolar S (2019) Magnetic resonance imaging evaluation of the effects of cigarette and maras powder (smokeless tobacco) on lumbar disc degeneration. Clin Neurol Neurosurg 186:105500. https://doi.org/10.1016/j.clineuro.2019.105500

    Article  PubMed  Google Scholar 

  4. Elsholtz FHJ, Schaafs L‑A, Köhlitz T, Hamm B, Niehues SM (2017) Periradicular infiltration of the lumbar spine: testing the robustness of an interventional ultra-low-dose protocol at different body mass index levels. Acta Radiol 58(11):1364–1370. https://doi.org/10.1177/0284185117694508

    Article  PubMed  Google Scholar 

  5. Friedly JL, Comstock BA, Turner JA, Heagerty PJ, Deyo RA (2017) Long-term effects of repeated injections of local anesthetic with or without corticosteroid for lumbar spinal stenosis: a randomized trial. Arch Phys Med Rehabil 98(8):1499–1507.e2. https://doi.org/10.1016/j.apmr.2017.02.029

    Article  PubMed  Google Scholar 

  6. Goode AP, Carey TS, Jordan JM (2013) Low back pain and lumbar spine osteoarthritis: how are they related? Curr Rheumatol Rep 15(2):305. https://doi.org/10.1007/s11926-012-0305-z

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gossner J (2019) Epidural Spinal Injections in Spinal Stenosis due to Lipomatosis: With or without Steroids? AJNR Am J Neuroradiol. https://doi.org/10.3174/ajnr.A6128

    Article  PubMed  PubMed Central  Google Scholar 

  8. https://www.awmf.org/leitlinien/detail/ll/029-006.html

  9. Kennedy DJ, Plastaras C, Casey E, Visco CJ, Rittenberg JD, Conrad B et al (2014) Comparative effectiveness of lumbar transforaminal epidural steroid injections with particulate versus nonparticulate corticosteroids for lumbar radicular pain due to intervertebral disc herniation: a prospective, randomized, double-blind trial. Pain Med 15(4):548–555. https://doi.org/10.1111/pme.12325

    Article  PubMed  Google Scholar 

  10. Manchikanti L, Candido KD, Kaye AD, Boswell MV, Benyamin RM, Falco FJE et al (2014) Randomized trial of epidural injections for spinal stenosis published in the New England Journal of Medicine: further confusion without clarification. Pain Physician 17(4):E475–E488

    PubMed  Google Scholar 

  11. Manchikanti L, Pampati V, Benyamin RM, Boswell MV (2015) Analysis of efficacy differences between caudal and lumbar interlaminar epidural injections in chronic lumbar axial discogenic pain: local anesthetic alone vs. local combined with steroids. Int J Med Sci 12(3):214–222. https://doi.org/10.7150/ijms.10870

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. McCormick Z, Kennedy DJ, Garvan C, Rivers E, Temme K, Margolis S et al (2015) Comparison of pain score reduction using triamcinolone vs. betamethasone in transforaminal epidural steroid injections for lumbosacral radicular pain. Am J Phys Med Rehabil 94(12):1058–1064. https://doi.org/10.1097/PHM.0000000000000296

    Article  PubMed  Google Scholar 

  13. Rubin DI (2007) Epidemiology and risk factors for spine pain. Neurol Clin 25(2):353–371. https://doi.org/10.1016/j.ncl.2007.01.004

    Article  PubMed  Google Scholar 

  14. Shakir A, Ma V, Mehta B (2013) Comparison of pain score reduction using triamcinolone vs. dexamethasone in cervical transforaminal epidural steroid injections. Am J Phys Med Rehabil 92(9):768–775. https://doi.org/10.1097/PHM.0b013e318282c9

    Article  PubMed  Google Scholar 

  15. Shanthanna H, Busse JW, Thabane L, Paul J, Couban R, Choudhary H et al (2016) Local anesthetic injections with or without steroid for chronic non-cancer pain: a protocol for a systematic review and meta-analysis of randomized controlled trials. Syst Rev 5:18. https://doi.org/10.1186/s13643-016-0190-z

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Radiologie München, Säbener Str. 51, 81547, München, Deutschland

    Martin G. Mack

Authors
  1. Martin G. Mack
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  2. Marc Regier
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  3. Christopher Herzog
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Corresponding author

Correspondence to Martin G. Mack.

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Interessenkonflikt

M.G. Mack, M. Regier und C. Herzog geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Mack, M.G., Regier, M. & Herzog, C. Facetteninfiltration und periradikuläre Therapie. Radiologe 60, 132–137 (2020). https://doi.org/10.1007/s00117-019-00634-9

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  • DOI: https://doi.org/10.1007/s00117-019-00634-9

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