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Das degenerativ veränderte lumbale Facettengelenk

Diagnostik, Klassifikation und minimal-invasive Behandlungsmöglichkeiten

Lumbar facet joint disease

Classification, clinical diagnostics, and minimally invasive treatment

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.

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.

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Abbreviations

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

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Correspondence to Florian Faber.

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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.

Additional information

Abbildungen mit freundlicher Unterstützung durch Klaus Bahringer (Medienabteilung der Orthopädischen Klinik, Universität Regensburg, Bad Abbach)

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Faber, F. Das degenerativ veränderte lumbale Facettengelenk. Orthopäde 48, 77–83 (2019). https://doi.org/10.1007/s00132-018-03667-5

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Schlüsselwörter

  • Kryotherapie
  • Debridement
  • Kreuzschmerz
  • Lendenwirbel
  • Wirbelsäule

Keywords

  • Cryotherapy
  • Debridement
  • Low back pain
  • Lumbar vertebrae
  • Spine