Zusammenfassung
Aufgrund geringer anatomischer und pathophysiologischer Kenntnisse des diskogenen Nervenkompressionssyndroms waren die Behandlungsmöglichkeiten sowohl während der Antike als auch im Mittelalter beschränkt und meist wenig spezifisch. Hervorzuheben ist die Streckbank (Scamnum Hippocratis), die aber für ganz unterschiedliche Rückenleiden Verwendung fand. Erst mit dem Zuwachs der anatomischen Kenntnisse und Fortschritte im Bereich der Asepsis, Anästhesie und Chirurgie seit Anfang des 19. Jahrhunderts erfolgten vermehrt spinalchirurgische Eingriffe. Im Jahr 1908 hatte der Neurologe Oppenheim (1858–1919) zusammen mit dem Chirurgen Feodor Krause (1857–1937) eine Bandscheibenoperation initiiert und erfolgreich durchgeführt, hat aber die Pathologie als solche verkannt. William Jason Mixter (1880–1958) und Joseph Seaton Barr (1901–1963) haben 1934 die diskogen bedingte Nervenkompression als Krankheitsbild und ihre chirurgische Therapie etabliert. Seither hat der Eingriff an der Bandscheibe rapide zugenommen. Die chirurgischen Behandlungsmöglichkeiten haben sich ebenso rasch gewandelt und seit der Einführung des Operationsmikroskops in den 60er Jahren des 20. Jahrhunderts auch verfeinert und den Weg zur chirurgischen Mikrodiskektomie geebnet. Es wurde bald auch nach alternativen, minimal-invasiven Verfahren gesucht. So wurde 1964 die Chemonukleolyse vom Orthopäden Lyman Smith (1912–1991) eingeführt, ein minimal-invasives Verfahren, bei dem unter Durchleuchtung eine proteolytische Enzymlösung ins Bandscheibenfach appliziert wurde. Bereits 1975 erfolgte die Erstbeschreibung der perkutanen Nukleotomie durch den Japaner Sadahisa Hijikata, die anstelle einer Enzymlösung Arbeitsinstrumente zur Extraktion von Bandscheibengewebe unter Durchleuchtung in den jeweilige Bandscheibenraum brachte. Seither wurden weitere Varianten der minimal-invasiven Verfahren entwickelt. Ebenso wurde die Mikrodiskektomie technisch vorangetrieben, welche bis heute das Standardverfahren geblieben ist.
Abstract
In ancient times as well as in the Middle Ages treatment options for discogenic nerve compression syndrome were limited and usually not very specific because of low anatomical and pathophysiological knowledge. The stretch rack (scamnum Hippocratis) was particularly prominent but was widely used as a therapeutic device for very different spinal disorders. Since the beginning of the nineteenth century anatomical knowledge increased and the advances in the fields of asepsis, anesthesia and surgery resulted in an increase in surgical interventions on the spine. In 1908 the first successful lumbar discectomy was initiated and performed by the German neurologist Heinrich O. Oppenheim (1858–1919) and the surgeon Fedor Krause (1857–1937); however, neither recognized the true pathological condition of discogenic nerve compression syndrome. With the landmark report in the New England Journal of Medicine in 1934, the two American surgeons William Jason Mixter (1880–1958) and Joseph Seaton Barr (1901–1963) finally clarified the pathomechanism of lumbar disc herniation and furthermore, propagated discectomy as the standard therapy. Since then interventions on intervertebral discs rapidly increased and the treatment options for lumbar disc surgery quickly evolved. The surgical procedures changed over time and were continuously being refined. In the late 1960s the surgical microscope was introduced for spinal surgery by the work of the famous neurosurgeon Mahmut Gazi Yasargil and his colleague Wolfhard Caspar and so-called microdiscectomy was introduced. Besides open discectomy other interventional techniques were developed to overcome the side effects of surgical procedures. In 1964 the American orthopedic surgeon Lyman Smith (1912–1991) introduced chemonucleolysis, a minimally invasive technique consisting only of a cannula and the proteolytic enzyme chymopapain, which is injected into the disc compartment to dissolve the displaced disc material. In 1975 the Japanese orthopedic surgeon Sadahisa Hijikata described percutaneous discectomy for the first time, which was a further minimally invasive surgical technique. Further variants of minimally invasive surgical procedures, such as percutaneous laser discectomy in 1986 and percutaneous endoscopic microdiscectomy in 1997, were also introduced; however, open discectomy, especially microdiscectomy remains the therapeutic gold standard for lumbar disc herniation.
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Gruber, P., Böni, T. Ischias. Unfallchirurg 118 (Suppl 1), 53–65 (2015). https://doi.org/10.1007/s00113-015-0099-3
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DOI: https://doi.org/10.1007/s00113-015-0099-3