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Der Radiologe

, Volume 46, Issue 6, pp 520–526 | Cite as

Facettenblockade, peridurale und periradikuläre Schmerztherapie

  • T. WaggershauserEmail author
  • S. Schwarzkopf
  • M. Reiser
Rückenschmerz: Diagnostik und Intervention

Zusammenfassung

Mehr als 80% der vertebragenen lumbalen Schmerzen sind unspezifisch und können nur schwer einer bestimmten anatomischen Struktur zugeordnet werden. Die Schmerzen können von den Bandscheiben, den Zwischenwirbel- und Iliosakralgelenken, der Muskulatur und den Bändern ausgehen.

In höchstens 7% der Fälle sind die Schmerzen radikulär (4% durch Bandscheiben, 3% durch Stenosen). In 7–15% der Fälle liegt die Schmerzursache im Bereich der Wirbelgelenke, in bis zu 15% im Bereich der Iliosakralgelenke (ISG). Obschon die überwältigende Mehrheit der Schmerzen keine eindeutige strukturelle Ursache hat, werden Infiltrationen von Medikamenten und Nervenblockaden häufig angewendet.

Ihre Wirksamkeit wurde aber bisher bis auf die epidurale Injektion von Kortikosteroiden bei radikulären Schmerzen in kontrollierten Studien nicht nachgewiesen.

Epidural und epiradikulär applizierte Kortikosteroide scheinen bei radikulären Schmerzen zumindest kurzfristig wirksam zu sein, obwohl kontrollierte Studien zu kontroversen Ergebnissen kommen. Die Problematik liegt z. T. in der räumlich exakten Applikation des Medikaments an der betroffenen Wurzel.

Dies ist bei der kaudalen Injektion kaum, bei der lumbalen epiduralen Injektion und bei periradikulären Injektionen sicher nur unter Röntgenkontrolle oder besser noch CT-gesteuert möglich.

Schlüsselwörter

Facettenblockade Wurzelblockade Periradikuläre Therapie ISG-Blockade 

Facet blockade, peridural and periradicular pain therapy

Abstract

More than 80% of vertebrogenic lumbar pain is unspecific and can only be attributed to a specific anatomic structure with difficulty. The pain can emanate from the intervertebral discs, intervertebral and sacroiliac (SI) joints, musculature, and ligaments.

In a maximum of 7% of cases, the pain is radicular (4% due to intervertebral discs and 3% caused by stenoses). In 7–15% of cases, the pain’s origin is located in the region of the vertebral joints and in up to 15% in the region of the SI joint. Although the overwhelming majority of pain has no clear structural cause, infiltrations of medications and nerve blockades are frequently employed.

The efficacy of these procedures has however not been verified in controlled studies with the exception of epidural injection of corticosteroids for radicular pain.

Epidural and epiradicular application of corticosteroids appear to be effective for radicular pain, at least on a short-term basis, although controlled studies have yielded controversial results. The difficulty lies partly in the exact placement at the affected root for applying the medication.

This is hardly possible with a caudal injection, while with a lumbar peridural injection and periradicular injections it is only possible under X-ray control or even better CT guidance.

Keywords

Facet blockade Root blockade Periradicular therapy Sacroiliac joint blockade 

Notes

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.Institut für klinische RadiologieKlinikum Großhadern der Ludwig-Maximilians-UniversitätMünchen
  2. 2.Institut für Gesundheits- und RehabilitationswissenschaftenKlinikum der Ludwig-Maximilians-UniversitätMünchen

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