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Das degenerativ veränderte lumbale Facettengelenk

Diagnostik, Klassifikation und minimal-invasive Behandlungsmöglichkeiten
  • Florian FaberEmail author
Leitthema

Zusammenfassung

Hintergrund

Die lumbale Facettengelenkdegeneration ist ein multifaktorieller Prozess, welcher eng mit der altersbedingten Degeneration der Bandscheibe verbunden ist und bei älteren Patienten mit einer Häufigkeit zwischen 15 und bis zu 40 % auftreten kann. Darüber hinaus zeigen jüngere Studien einen Zusammenhang zwischen dem verstärkten Auftreten von Entzündungsmediatoren und afferenter Schmerzweiterleitung am Facettengelenk.

Operative Techniken

Die Erstbeschreibung einer minimal-invasiven Technik zur symptomatischen Therapie der degenerativen Facettengelenkerkrankung geht auf das Jahr 1975 zurück. In der Folgezeit wurden weitere Techniken entwickelt, mit unterschiedlichem Wirkungserfolg. Die anatomischen Zielstrukturen der unterschiedlichen Techniken sind entweder der mediale Ast des Ramus dorsalis oder die Facettengelenkkapsel. Die wichtigsten Techniken sind heutzutage die Thermorhizotomie (Thermodenervierung), die Kryorhizotomie (Kryotherapie) und das endoskopische oder perkutane Facettengelenk-Debridement.

Schlüsselwörter

Kryotherapie Debridement Kreuzschmerz Lendenwirbel Wirbelsäule 

Abkürzungen

BW

Bildwandler

CD

„Cluster of differentiation“

CGRP

„Calcitonin gene related peptide“

CT

Computertomographie

IL

Interleukin

LWK

Lendenwirbelkörper

LWS

Lendenwirbelsäule

MRT

Magnetresonanztomografie

NGF

„Nerve growth factor“

NPY

Neuropeptid Y

PGP9.5

„Protein gene product 9.5“

RFA

Radiofrequenzablation

SP

Substanz P

TH

Tyroxinhydroxylase

TNF

Tumornekrosefaktor

VEGF

„Vascular endothelial growth factor“

VIP

Vasoaktives intestinales Peptid

Lumbar facet joint disease

Classification, clinical diagnostics, and minimally invasive treatment

Abstract

Background

The degeneration of the lumbar facet joint is a multi-factorial process that is closely linked to degeneration of the intervertebral discs and has been implicated as one of the causes of low-back pain of elderly patients in about 15 up to 40% of cases. Moreover, emerging data suggest that increased inflammatory features play an important role in the progression of lumbar facet joint disease and may serve as a link to the afferent pain nerve fibers.

Operative techniques

Since the first description in 1975 of minimally invasive treatment of lumbar facet joint disease, different techniques have been developed and used with varying results. Today, the major techniques are thermorhizotomy, cryorhizotomy, and endoscopic or percutaneous facet debridement with different anatomical targets, such as the medial branch of the dorsal ramus or facet joint capsule.

Keywords

Cryotherapy Debridement Low back pain Lumbar vertebrae Spine 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

F. Faber weist auf folgende Beziehung hin: Beratervertrag von der Firma Medovex.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Andersson GB (1999) Epidemiological features of chronic low-back pain. Lancet 354(9178):581–585CrossRefGoogle Scholar
  2. 2.
    Gellhorn AC, Katz JN, Suri P (2013) Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol 9(4):216–224.  https://doi.org/10.1038/nrrheum.2012.199 CrossRefGoogle Scholar
  3. 3.
    Cohen SP, Huang JH, Brummett C (2013) Facet joint pain—advances in patient selection and treatment. Nat Rev Rheumatol 9(2):101–116.  https://doi.org/10.1038/nrrheum.2012.198 CrossRefGoogle Scholar
  4. 4.
    Moore RJ, Crotti TN, Osti OL, Fraser RD, Vernon-Roberts B (1999) Osteoarthrosis of the facet joints resulting from anular rim lesions in sheep lumbar discs. Spine 24:519–525CrossRefGoogle Scholar
  5. 5.
    Vernon-Roberts B, Pirie CJ (1977) Degenerative changes in the intervertebral discs of the lumbar spine and their sequelae. Rheumatol Rehabil 16:13–21CrossRefGoogle Scholar
  6. 6.
    Haefeli M (2006) The course of macroscopic degeneration in the human lumbar intervertebral disc. Spine 31(14):1522–1531CrossRefGoogle Scholar
  7. 7.
    Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 26(17):1873–1878CrossRefGoogle Scholar
  8. 8.
    Boden SD, Davis DO, Dina TM, Patronas NJ, Wiesel SW (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. J Bone Joint Surg Am 72:403–408CrossRefGoogle Scholar
  9. 9.
    Butler D, Trafimow JH, Andersson GBJ, McNeil TW, Huckman MS (1990) Discs degenerate before facets. Spine 15:111–113CrossRefGoogle Scholar
  10. 10.
    Fujiwara A, Tamai K, Yamato M, An HS, Yoshida H, Saotome K, Kurihashi A (1999) The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Eur Spine J 8(5):396–401CrossRefGoogle Scholar
  11. 11.
    Varlotta GP, Lefkowitz TR, Schweitzer M, Errico TJ, Spivak J, Bendo JA, Rybak L (2011) The lumbar facet joint: a review of current knowledge: part 1: anatomy, biomechanics, and grading. Skeletal Radiol 40(1):13–23CrossRefGoogle Scholar
  12. 12.
    Vandenabeele (1997) Encapsulated Ruffini-like endings in human lumbar facet joints. J Anat 191(Pt 4):571–583CrossRefGoogle Scholar
  13. 13.
    Inami S, Shiga T, Tsujino A, Yabuki T, Okado N, Ochiai N (2001) Immunohistochemical demonstration of nerve fibers in the synovial fold of the human cervical facet joint. J Ortho Res 19:593–596CrossRefGoogle Scholar
  14. 14.
    Giles LG, Harvey AR (1987) Immunohistochemical demonstration of nociceptors in the capsule and synovial folds of human zygapophyseal joints. Br J Rheumatol 26(5):362–364CrossRefGoogle Scholar
  15. 15.
    Netzer C, Urech K, Hügle T, Benz RM, Geurts J, Schären S (2016) Characterization of subchondral bone histopathology of facet joint osteoarthritis in lumbar spinal stenosis. J Orthop Res 34(8):1475–1480CrossRefGoogle Scholar
  16. 16.
    Youssef P, Loukas M, Chapman JR, Oskouian RJ, Tubbs RS (2016) Comprehensive anatomical and immunohistochemical review of the innervation of the human spine and joints with application to an improved understanding of back pain. Childs Nerv Syst 32(2):243–251CrossRefGoogle Scholar
  17. 17.
    Ashton IK (1992) Morphological basis for back pain: the demonstration of nerve fibers and neuropeptides in the lumbar facet joint capsule but not in ligamentum flavum. J Orthop Res 10(1):72–78CrossRefGoogle Scholar
  18. 18.
    Beaman DN, Graziano GP, Glover RA, Wojtys EM, Chang V (1976) Substance P innervation of lumbar spine facet joints. Spine 18(8):1044–1049CrossRefGoogle Scholar
  19. 19.
    Ahmed M, Bjurholm A, Kreichergs A, Schultzberg M (1993) Neuropeptide Y, tyrosine hydroxylase and vasoactive intestinal polypeptide-immunoreactive nerve fibers in the vertebral bodies, discs, duramater and spinal ligaments of the rat lumbar spine. Spine 18:268–273CrossRefGoogle Scholar
  20. 20.
    Kallakuri S, Singh A, Chen C, Cavanaugh JM (1976) Demonstration of substance P, calcitonin gene-related peptide, and protein gene product 9.5 containing nerve fibers in human cervical facet joint capsules. Spine 29(11):1182–1186CrossRefGoogle Scholar
  21. 21.
    Kim JS, Ali MH, Wydra F, Li X, Hamilton JL, An HS, Cs-Szabo G, Andrews S, Moric M, Xiao G, Wang JH, Chen D, Cavanaugh JM, Im HJ (2015) Characterization of degenerative human facet joints and facet joint capsular tissues. Osteoarthritis Cartilage 23(12):2242–2251CrossRefGoogle Scholar
  22. 22.
    Kettler A, Wilke HJ (2006) Review of existing grading systems for cervical or lumbar disc and facet joint degeneration. Eur Spine J 15(6):705–718CrossRefGoogle Scholar
  23. 23.
    Pathria M, Sartoris DJ, Resnick D (1987) Osteoarthritis of the facet joints: accuracy of oblique radiographic assessment. Radiology 164(1):227–230CrossRefGoogle Scholar
  24. 24.
    Weishaupt D, Zanetti M, Boos N, Hodler J (1999) MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol 28(4):215–219CrossRefGoogle Scholar
  25. 25.
    Lee JC, Cha JG, Yoo JH, Kim HK, Kim HJ, Shin BJ (2012) Radiographic grading of facet degeneration, is it reliable?—a comparison of MR or CT grading with histologic grading in lumbar fusion candidates. Spine J 12(6):507–514CrossRefGoogle Scholar
  26. 26.
    Rihn JA (1976) Does lumbar facet fluid detected on magnetic resonance imaging correlate with radiographic instability in patients with degenerative lumbar disease? Spine 32(14):1555–1560CrossRefGoogle Scholar
  27. 27.
    Birkenmaier C, Veihelmann A, Trouillier HH, Hausdorf J, von Schulze Pellengahr C (2007) Medial branch blocks versus pericapsular blocks in selecting patients for percutaneous cryodenervation of lumbar facet joints. Reg Anesth Pain Med 32(1):27–33CrossRefGoogle Scholar
  28. 28.
    Loizides A, Gruber H, Peer S, Galiano K, Bale R, Obernauer J (2013) Ultrasound guided versus CT-controlled pararadicular injections in the lumbar spine: a prospective randomized clinical trial. AJNR Am J Neuroradiol 34(2):466–470CrossRefGoogle Scholar
  29. 29.
    Wu T, Zhao WH, Dong Y, Song HX, Li JH (2016) Effectiveness of ultrasound-guided versus fluoroscopy or computed tomography scanning guidance in lumbar facet joint injections in adults with facet joint syndrome: a Meta-analysis of controlled trials. Arch Phys Med Rehabil 97(9):1558–1563CrossRefGoogle Scholar
  30. 30.
    Faber F, Benditz A, Boluki D, Grifka J (2018) The application of different injection methods for cervical and lumbar syndromes. Schmerz 32(1):65–85CrossRefGoogle Scholar
  31. 31.
    Benditz A, Madl M, Loher M, Grifka J, Boluki D, Linhardt O (2016) Prospective medium-term results of multimodal pain management in patients with lumbar radiculopathy. Sci Rep 6:28187CrossRefGoogle Scholar
  32. 32.
    Brunner M, Schwarz T, Zeman F, König M, Grifka J, Benditz A (2018) Efficiency and predictive parameters of outcome of a multimodal pain management concept with spinal injections in patients with low back pain: a retrospective study of 445 patients. Arch Orthop Trauma Surg 138(7):901–909CrossRefGoogle Scholar
  33. 33.
    Shealy CN (1975) Percutaneous radiofrequency denervation of spinal facets: treatment for chronic back pain and sciatica. J Neurosurg 43(4):448–451CrossRefGoogle Scholar
  34. 34.
    Leclaire R, Fortin L, Lambert R, Bergeron YM, Rossignol M (2001) Radiofrequency facet joint denervation in the treatment of low back pain: a placebo-controlled clinical trial to assess efficacy. Spine 26(13):1411–1416CrossRefGoogle Scholar
  35. 35.
    Nath S, Nath CA, Pettersson K (1976) Percutaneous lumbar zygapophysial (Facet) joint neurotomy using radiofrequency current, in the management of chronic low back pain: a randomized double-blind trial. Spine 33(12):1291–1297CrossRefGoogle Scholar
  36. 36.
    Al-Najjim M, Shah R, Rahuma M, Gabbar OA (2017) Lumbar facet joint injection in treating low back pain: radiofrequency denervation versus SHAM procedure. Systematic review. J Orthop 15(1):1–8CrossRefGoogle Scholar
  37. 37.
    Bärlocher CB, Krauss JK, Seiler RW (2003) Kryorhizotomy: an alternative technique for lumbar medial branch rhizotomy in lumbar facet syndrome. J Neurosurg 98(1 Suppl):14–20Google Scholar
  38. 38.
    Staender M, Maerz U, Tonn JC, Steude U (2005) Computerized tomography-guided kryorhizotomy in 76 patients with lumbar facet joint syndrome. J Neurosurg Spine 3(6):444–449CrossRefGoogle Scholar
  39. 39.
    Andres RH, Graupner T, Bärlocher CB, Augsburger A, Fandino J (2010) Laser-guided lumbar medial branch kryorhizotomy. J Neurosurg Spine 13(3):341–345.  https://doi.org/10.3171/2010.3.SPINE09609 CrossRefGoogle Scholar
  40. 40.
    Moussa WM, Khedr W (2016) Percutaneous radiofrequency facet capsule denervation as an alternative target in lumbar facet syndrome. Clin Neurol Neurosurg 150:96–104CrossRefGoogle Scholar
  41. 41.
    Haufe SM, Mork AR (2010) Endoscopic facet debridement for the treatment of facet arthritic pain—a novel new technique. Int J Med Sci 7(3):120–123CrossRefGoogle Scholar
  42. 42.
    Kettler A, Wilke HJ (2006) Review of existing grading systems for cervical or lumbar disc and facet joint degeneration. Eur Spine J 15(6):705–718 (Jun)CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Orthopädische Universitätsklinik Regensburg, Asklepios Klinikum Bad AbbachUniversität RegensburgBad AbbachDeutschland

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