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Diagnostik und minimal-invasive Therapie bei chronischen Lumbalgien

Diagnostics and minimally invasive therapy for chronic low back pain

  • Schwerpunkt: Orthopädische Schmerztherapie
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Zusammenfassung

Die chronische Lumbalgie zählt zu den häufigsten Ursachen für Arztbesuche in Deutschland. Ihre kausale Pathogenese ist multifaktoriell. Hierin ist die große Problematik für die diagnostische Eingrenzung und nachfolgende therapeutische Konsequenz zu sehen. Einigkeit besteht übergreifend in der Vorstellung, wann sinnvoller Weise eine weiterführende Diagnostik begonnen werden soll. Abgesehen von eindeutigen pathomorphologischen Befunden und Leit- bzw. Warnsymptomen, sog. „red flags“, sollte der primäre Rückenschmerz innerhalb der ersten 3 Monate keiner spezifischen Diagnostik und Therapie unterworfen werden. Im Einzelnen werden in diesem Beitrag die gängigen Blockadetechniken, die Diskographie sowie minimal-invasive Therapieoptionen wie die Kryotherapie, die thermischen Ablationsverfahren und die intradiskale Elektrotherapie dargestellt. Auch die Vertebroplastie als aktuell häufig angewendetes Verfahren wurde in die minimal-invasive Therapie chronischer Lumbalgien mit einbezogen.

Abstract

Chronic low back pain is one of the most frequent causes for seeking medical help in Germany. Many factors play a causal role in its pathogenesis. This is where the dilemma resides in narrowing down the diagnosis and deciding on subsequent therapeutic intervention. There is overall agreement on the concept of when it is expedient to initiate further diagnostic measures. With the exception of clear pathomorphological findings and the presence of cardinal symptoms or warning signs, so-called “red flags”, primary back pain should not be subjected to any specific diagnostic tests and therapy during the first 3 months. We present well-established techniques for blockade, discography, and minimally invasive treatment options such as cryotherapy, procedures for thermal ablation, and intradiscal electrotherapy. Vertebroplasty, currently a frequently applied method, is also included in the discussion of minimally invasive treatment for chronic low back pain.

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  1. Abteilung für Wirbelsäulenchirurgie, Orthopädische Universitätsklinik—Stiftung Friedrichsheim—Frankfurt

    M. A. Rauschmann, J. Warzecha, M. Arabmotlagh, A. Mayer & D. v. Stechow

  2. Abteilung für Wirbelsäulenchirurgie, Orthopädische Universitätsklinik—Stiftung Friedrichsheim, Marienburgstr. 2, 62528, Frankfurt am Main

    M. A. Rauschmann

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  1. M. A. Rauschmann
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Correspondence to M. A. Rauschmann.

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Rauschmann, M.A., Warzecha, J., Arabmotlagh, M. et al. Diagnostik und minimal-invasive Therapie bei chronischen Lumbalgien. Schmerz 18, 463–474 (2004). https://doi.org/10.1007/s00482-003-0301-3

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