Der Orthopäde

, Volume 37, Issue 4, pp 300–306 | Cite as

Postnukleotomiesyndrom

Operationsindikation, konservative und operative Behandlungsmöglichkeiten
Leitthema

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.

Schlüsselwörter

Postnukleotomiesyndrom Instabilität Diskogener Rückenschmerz Fusion Bandscheibenprothese 

Post disc surgery syndrome

Indications for surgery and conservative and operative treatment possibilities

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.

Keywords

Recurrent disc herniation Chronic low back pain Instability Discogenic low back pain Total disc arthroplasty 

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Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Alfried Krupp KrankenhausKlinik für Orthopädie und orthopädische Chirurgie mit SportmedizinEssenDeutschland

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