Zusammenfassung
Hintergrund
Das Postnukleotomiesyndrom umfasst alle auftretenden Folgeerscheinungen nach durchgeführter Nukleotomie im Rahmen der operativen Entfernung eines lumbalen Bandscheibenvorfalls, wie axialer Rückenschmerz und persistierende Radikulopathie.
Ziel der Arbeit
Beschreibung zugrunde liegender Pathologien und zur Verfügung stehender operativer Therapieoptionen.
Material und Methoden
Es erfolgte eine ausführliche Literaturrecherche über Medline.
Ergebnisse
Für die Behandlung kamen in den letzten Jahrzehnten verschiedenste Verfahren und Implantate auf den Markt. Trotzdem ist die operative und nichtoperative Therapie des Postnukleotomiesyndroms noch immer komplex und häufig von Misserfolg geprägt.
Diskussion
Bessere Studien zu den einzelnen Subentitäten des Postnukleotomiesyndroms sind notwendig, um eine ausreichende Evidenz zu schaffen.
Abstract
Background
Post-nucleotomy syndrome includes all existing sequelae after surgical nucleotomy for the resection of a lumbar disc herniation, such as axial lumbar back pain and persisting radiculopathy.
Objectives
To describe underlying pathologies and to determine operative treatment options.
Materials and methods
Extensive literature research was carried out on Medline.
Results
Various devices and approaches have been developed in the last decades. Nonetheless, surgical and non-surgical therapy of post-nucleotomy syndrome remains complex and frequently fails.
Conclusions
Better studies providing a better level of evidence for each sub-entity of post-nucleotomy syndrome are required.
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Literatur
Barth M, Diepers M, Weiss C et al (2008) Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 2: radiographic evaluation and correlation with clinical outcome. Spine (Phila Pa 1986) 33:273–279
Barth M, Weiss C, Thome C (2008) Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: Part 1: Evaluation of clinical outcome. Spine (Phila Pa 1986) 33:265–272
Chou D, Lau D, Skelly A et al (2011) Dynamic stabilization versus fusion for treatment of degenerative spine conditions. Evid Based Spine Care J 2:33–42
Desai A, Ball PA, Bekelis K et al (2011) Outcomes after incidental durotomy during first-time lumbar discectomy. J Neurosurg Spine 14:647–653
El Barzouhi A, Vleggeert-Lankamp CL, Lycklama a Nijeholt GJ et al (2013) Magnetic resonance imaging in follow-up assessment of sciatica. N Engl J Med 368:999–1007
Gornet MF, Burkus JK, Dryer RF et al (2011) Lumbar disc arthroplasty with Maverick disc versus stand-alone interbody fusion: A prospective, randomized, controlled, multicenter investigational device exemption trial. Spine (Phila Pa 1986) 36:E1600–E1611
Jahng TA, Kim YE, Moon KY (2013) Comparison of the biomechanical effect of pedicle-based dynamic stabilization: A study using finite element analysis. Spine J 13:85–94
Korovessis P, Papazisis Z, Koureas G et al (2004) Rigid, semirigid versus dynamic instrumentation for degenerative lumbar spinal stenosis: A correlative radiological and clinical analysis of short-term results. Spine (Phila Pa 1986) 29:735–742
Kumar K, Taylor RS, Jacques L et al (2007) Spinal cord stimulation versus conventional medical management for neuropathic pain: A multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain 132:179–188
Liu HY, Zhou J, Wang B et al (2012) Comparison of Topping-off and posterior lumbar interbody fusion surgery in lumbar degenerative disease: A retrospective study. Chin Med J 125:3942–3946
Manchikanti L, Kaye AD, Boswell MV et al (2015) A systematic review and best evidence synthesis of the effectiveness of therapeutic facet joint interventions in managing chronic spinal pain. Pain Physician 18:E535–E582
Onesti ST (2004) Failed back syndrome. Neurologist 10:259–264
Parker SL, Grahovac G, Vukas D et al (2013) Effect of an annular closure device (Barricaid) on same level recurrent disc herniation and disc height loss after primary lumbar Discectomy: Two-year results of a multi-center prospective cohort study. J Spinal Disord Tech. doi:10.1097/bsd.0b013e3182956ec5
Rickert M, Rauschmann M, Fleege C et al (2015) Interbody fusion procedures. Orthopade 44:104–113
Steib K, Proescholdt M, Brawanski A et al (2012) Predictors of facet joint syndrome after lumbar disc surgery. J Clin Neurosci 19:418–422
Taylor RS, Van Buyten JP, Buchser E (2005) Spinal cord stimulation for chronic back and leg pain and failed back surgery syndrome: A systematic review and analysis of prognostic factors. Spine (phila Pa 1986) 30:152–160
Taylor RS, Desai MJ, Rigoard P et al (2014) Predictors of pain relief following spinal cord stimulation in chronic back and leg pain and failed back surgery syndrome: A systematic review and meta-regression analysis. Pain Pract 14:489–505
Trummer M, Eustacchio S, Barth M et al (2013) Protecting facet joints post-lumbar discectomy: Barricaid annular closure device reduces risk of facet degeneration. Clin Neurol Neurosurg 115:1440–1445
Von Strempel A (2010) Dynamic posterior stabilization with the cosmic system. Oper Orthop Traumatol 22:561–572
Wang JC, Dailey AT, Mummaneni PV et al (2014) Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: Lumbar fusion for disc herniation and radiculopathy. J Neurosurg Spine 21:48–53
Zigler JE, Delamarter RB (2012) Five-year results of the prospective, randomized, multicenter, Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential arthrodesis for the treatment of single-level degenerative disc disease. J Neurosurg Spine 17:493–501
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S. Krieg ist Berater für BrainLAB AG (Feldkirchen, Deutschland) und Nexstim Oy (Helsinki, Finnland). B. Meyer ist Berater für Ulrich Medical (Ulm, Deutschland), Medtronic (Dublin, Irland), Relievant Medsystems Inc. (Redwood City, USA), DePuy Synthes (West Chester, USA) und BrainLAB AG (Feldkirchen, Deutschland).
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
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Krieg, S.M., Meyer, B. Operative Therapiemöglichkeiten beim Postnukleotomiesyndrom. Orthopäde 45, 732–737 (2016). https://doi.org/10.1007/s00132-016-3309-y
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DOI: https://doi.org/10.1007/s00132-016-3309-y