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Minimalinvasive Schmerztherapie rund um die Wirbelsäule

Minimally invasive treatment of spinal pain

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Zusammenfassung

Hintergrund

Vertebragene Beschwerden sind häufig und oftmals schwierig zu behandeln. Neben dem persönlichen ist auch der volkswirtschaftliche Schaden enorm.

Fragestellung

Die vorliegende Arbeit soll einen Überblick über die heute gängigen schmerztherapeutischen Verfahren an der Wirbelsäule geben, die in erster Linie bei therapieresistenten Schmerzen ohne bestehende Operationsindikation zur Anwendung kommen.

Material und Methoden

Die verfügbare Literatur wurde mittels PubMed und Google Scholar sowie orthopädischer Lehrbücher gesichtet. Weiterführendenden Verweisen auf ältere Literatur wurde mit der Google-Suchfunktion und anhand der Zentralbibliothek der Medizinischen Universität Wien nachgegangen.

Ergebnisse

Neben röntgengesteuerten Infiltrationen stehen neuroablative und -modulierende Verfahren sowie die Kathetertechnik (Adhäsiolyse) zur Verfügung. Sie liefern bei korrekter Indikationsstellung durchweg gute Ergebnisse.

Schlussfolgerungen

Obwohl bei vielen Patienten in Anbetracht der Komplexität des Schmerzgeschehens eine völlige Beschwerdefreiheit kaum realistisch ist, kann mit den sich stetig weiterentwickelnden minimal-invasiven Verfahren eine auch klinisch relevante Schmerzreduktion erreicht werden. Aufgrund der geringen Gewebetraumatisierung gibt es kaum Narbenbildung und die Eingriffsrisiken sind bei korrekter Durchführung gering.

Abstract

Background

Spinal pain is common and often difficult to treat. In addition to the individual’s impairment, the economic damage is also enormous.

Objective

The present work aims to provide an overview of therapeutic procedures commonly used to treat spinal pain today. These methods are employed primarily for therapy-resistant pain without an existing surgical indication.

Materials and methods

The existing literature was reviewed using PubMed, Google Scholar, and orthopedic textbooks. Further references to older literature were investigated using the Google search function and the Central Library of the Medical University of Vienna.

Results

In addition to X‑ray-targeted infiltration, neuroablative and neuromodulatory procedures as well as adhesiolysis catheters are available. They provide consistently good results if correctly indicated.

Discussion

Although in many patients, given the complexity of the pain, complete freedom from symptoms is hardly realistic, the constantly evolving minimally invasive procedures enable a clinically relevant pain reduction to be achieved. Due to the low tissue traumatization there is hardly any scar formation, and the risks of the interventions are low if correctly performed.

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Authors and Affiliations

  1. Wirbelsäulenzentrum, Orthopädisches Spital Speising, Speisinger Strasse 109, 1130, Wien, Österreich

    Raphael Scheuer

  2. Ordination Wien 14, Diesterweggasse 19, 1140, Wien, Österreich

    Raphael Scheuer

  3. Ordination Wien 23, Brunner Strasse 20, 1230, Wien, Österreich

    Raphael Scheuer

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  1. Raphael Scheuer
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Correspondence to Raphael Scheuer.

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R. Scheuer gibt an, dass kein Interessenkonflikt besteht.

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

Additional information

Dieser Beitrag beruht auf einem Vortrag gehalten auf dem Kongress „Konservative Orthopädie im Fokus“ in Pörtschach im Juli 2017.

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Scheuer, R. Minimalinvasive Schmerztherapie rund um die Wirbelsäule. Manuelle Medizin 56, 49–53 (2018). https://doi.org/10.1007/s00337-017-0355-4

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