Skip to main content
SpringerLink
Log in

Postnukleotomiesyndrom

Operationsindikation, konservative und operative Behandlungsmöglichkeiten

Post disc surgery syndrome

Indications for surgery and conservative and operative treatment possibilities

  • Leitthema
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Das Postnukleotomiesyndrom zeichnet sich durch die Existenz persistierender und immobilisierender Schmerzen im LWS-Bereich, der Hüfte, des Kniegelenks oder des Beins aus. Diese können nach einem variablen Zeitraum im Gefolge der Erstoperation auftreten. Der Zeitpunkt des Auftretens ist von eminenter Bedeutung für die korrekte Diagnostik und Prognose der Erkrankung. Bei postoperativ persistierender Symptomatik ist üblicherweise von einer fehlerhaften Lokalisation des Eingriffs oder einer fehlerhaften Indikation auszugehen. Reprolapse zeigen ein plötzliches, im zeitlichen Abstand von der Erstoperation eintretendes Beschwerdebild. Mit zeitlichem Abstand zur Erstoperation auftretende Rückenschmerzen weisen auf Störungen der Stabilität und der Bandscheibenintegrität hin. Therapeutische Maßnahmen reichen von konservativer Therapie bei chronischem Schmerzsyndrom bis zu Renukleotomien, Versteifungen und Stabilisierungen bis hin zur Benutzung von Bandscheibenprothesen.

Abstract

Post disc surgery syndrome is characterised by the presence of persistent disabling pain in the hip, thigh, or lower back. Persistent or recurrent pain may be related to neurologic compression, incomplete discectomy with retained disc fragments, recurrent disc herniation, or altered biomechanics of the operated segments. Early failure is usually due to poor patient selection, incorrect diagnosis, incorrect procedure, or infection. A new onset of pain following a good surgical result may be due to recurrent disc herniation, instability of the operated segment, or disease at a different disc level. It can also be the result of a chronic pain syndrome. Therapy depends on exact diagnostics and can include conservative as well as surgical treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Broll-Zeitvogel E, Bauer J, Blunk R, Vormann U (2007) Schmerzbewältigung. Orthopäde 36(1): 66–72

    Article  PubMed  CAS  Google Scholar 

  2. Brox JI, Reikerås O, Nygaard Ø et al. (2006) Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study. Pain 122(1–2): 145–155

    Google Scholar 

  3. Burton CV, Kirkaldy-Willis WH, Yong-Hing K, Heithoff KB (1981) Causes of failure of surgery on the lumbar spine. Clin Orthop Rel Res 157:191–199

    Google Scholar 

  4. Carragee EJ, Han MY, Suen PW, Kim D (2003) Clinical outcomes after lumbar discectomy for sciatica: The effects of fragment type and anular competence. J Bone Joint Surg Am 85:102–108

    PubMed  Google Scholar 

  5. Cervellini P, Curri D, Volpin L et al. (1988) Computed tomography of epidural fibrosis after discectomy: A comparison between symptomatic and asymptomatic patients. Neurosurgery 23: 710–713

    Article  PubMed  CAS  Google Scholar 

  6. Cinotti G, Roysam GS, Eisenstein SM, et al (1998) Ipsilateral recurrent lumbar disc herniation. A prospective, controlled study. J Bone Joint Surg Br 80: 825–832

    Article  PubMed  CAS  Google Scholar 

  7. Davis RA (1994) A long-term outcome analysis of 984 surgically treated herniated lumbar discs. J Neurosurg 80: 415–421

    Article  PubMed  CAS  Google Scholar 

  8. Fairbank J, Frost H, Wilson-MacDonald J et al. (2005) Randomised controlled trial to compare surgical stabilisation of the lumbar spine versus an intensive rehabilitation programme for patients with chronic low back pain. BMJ 330: 1233–1238

    Article  PubMed  Google Scholar 

  9. Fischgrund JS (2000) Use of Adcon-L for Epidural Scar Prenvention.  J Am Acad Orthop Surg 8(6): 339–343

    PubMed  CAS  Google Scholar 

  10. Fritzell P, Hagg O, Wessberg P, Nordwall A (2002) 2001 Volvo Award Winner in Clinical Studies: Lumbar Fusion Versus Nonsurgical Treatment for Chronic Low Back Pain: A Multicenter Randomized Controlled Trial From the Swedish Lumbar Spine Study Group. Spine 26(23): 2521–2532

    Article  Google Scholar 

  11. Fritzell P, Hagg O, Wessberg P, Nordwall A (2002) Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish lumbar spine study group. Spine 27(11): 131–1141

    Article  Google Scholar 

  12. Hazard RG (2006) Failed back surgery syndrome: surgical and nonsurgical approaches. Clin Orthop Relat Res 443: 228–232

    Article  PubMed  Google Scholar 

  13. Hoffman RM, Wheeler K J, Deyo RA (1993) Surgery for herniated lumbar discs: a literature synthesis. J Gen Intern Med 8: 487–496

    Article  PubMed  CAS  Google Scholar 

  14. Ivanic GM, Pink PT, Schneider F et al. (2006) Prevention of epidural scarring after microdiscectomy: a randomized clinical trial comparing gel and expanded, polytetrafluoroethylene membrane.Eur Spine J 15: 1360–1366

    Article  PubMed  Google Scholar 

  15. Jensen TT, Asmussen K, Berg-Hansen EM, et al (1996) First-time operation for lumbardisc herniation with or without free fat transplantation: Prospective triple-blind randomized study with reference to clinical factors and enhanced computed tomographic scan 1 year after operation. Spine 21: 1072–1076

    Article  PubMed  CAS  Google Scholar 

  16. Linhardt O, Matussek J, Refior HJ, Krödel A (2007) Long-term results of ventro-dorsal versus ventral instrumentation fusion in the treatment of spondylitis. International Orthopaedics (SICOT) 31(1): 113–119

    Google Scholar 

  17. MacKay MA, Fischgrund JS, Herkowitz HN et al. (1995) The effect of interposition membrane on the outcome of lumbarlaminectomy and discectomy. Spine 20:1793–1796

    Article  PubMed  CAS  Google Scholar 

  18. Mirza SK, Deyp RA (2007) Systematic review of randomized trials comparing lumbar fusion surgery to nonoperative care for teatment of chronic back pain. Spine 32 (7): 816–823

    Article  PubMed  Google Scholar 

  19. Peng B, Hao J, Hou S et al. (2006) Possible pathogenesis of painful intervertebral dis generation. Spine 31(51): 560–566

    Article  PubMed  Google Scholar 

  20. Rohde V, Meyer B, Schaller C, Hassler WE (1998) Spondylodiscitis after lumbar discectomy: incidence and a proposal for prophylaxis. Spine. 23 (5):615–620

    Google Scholar 

  21. Schaible G (2007) Pathophysiologie des Schmerzes. Orthopäde 36(1): 8–16

    Article  PubMed  Google Scholar 

  22. Schofferman J, Reynolds J, Herzog R et al. (2003) Failed back surgery: etiology and diagnostic evaluation. Spine J 3(5): 400–403

    Article  PubMed  Google Scholar 

  23. Siepe CJ, Mayer HM, Wiechert K, Korge A (2007) Clinical results of total lumbar disc replacement with ProDiscII: Three-year results for different indication. Spine 31(17): 1923–1932

    Article  Google Scholar 

  24. Suk KS, Lee HM, Moon SH, et al (2001) Recurrent lumbar disc herniation: results of operative management. Spine 26: 672–676

    Article  PubMed  CAS  Google Scholar 

  25. de Tribolet N, Robertson JT (1996) Lack of postdiscectomy adhesions, following application of ADCONL a case report. Eur Spine J 5 (SuppI 1): 18–20

    Article  Google Scholar 

  26. Tullberg T, Grane P, Isacson J (1994) Gadolinium-enhanced magnetic resonance imaging of 36 patients one year after lumbardisc resection. Spine 19: 176–182

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Alfried Krupp Krankenhaus, Klinik für Orthopädie und orthopädische Chirurgie mit Sportmedizin, Alfried Krupp Straße 21, 45131, Essen, Deutschland

    A. Krödel

Authors
  1. A. Krödel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Krödel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Krödel, A. Postnukleotomiesyndrom. Orthopäde 37, 300–306 (2008). https://doi.org/10.1007/s00132-008-1226-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-008-1226-4

Schlüsselwörter

Keywords

Search

Navigation