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Epidurale Rückenmarkstimulation zur Therapie chronischer Schmerzen

Zusammenfassung der S3-Leitlinie

Epidural spinal cord stimulation for therapy of chronic pain

Summary of the S3 guidelines

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An Erratum to this article was published on 26 February 2012

Zusammenfassung

Die epidurale Rückenmarkstimulation (SCS) ist ein reversibles, aber invasives Verfahren, das bei neuropathischen Schmerzen, z. B. beim CRPS I und bei überwiegenden chronischen Radikulopathien im Rahmen eines Failed-back-surgery-Syndroms nach erfolgloser konservativer Therapie eingesetzt werden sollte. SCS kann auch dem Ausschluss von kurativen Verfahren und konservativen Therapieversuchen bei vaskulär bedingten Schmerzen wie z. B. der peripheren arteriellen Verschlusskrankheit Stadium II und III nach Fontaine und der therapierefraktären Angina pectoris erfolgreich zum Einsatz kommen. Die klinische Praxis hat gezeigt, bei welchen Krankheitsbildern die epidurale Rückenmarkstimulation keinen Erfolg hat, z. B. Schmerzen beim kompletten Querschnittsyndrom oder bei Atrophie/Verletzung der sensiblen Bahnen des Rückenmarks oder bei Karzinomschmerzen. Entscheidend ist neben der Diagnosestellung eine geeignete und kritische Patientenselektion. Die epidurale Rückenmarkstimulation sollte immer im Rahmen eines interdisziplinären multimodalen Therapiekonzepts eingesetzt werden. Die Implantation sollte nur in Therapiezentren erfolgen, die Erfahrung mit der Therapie haben und die in der Lage sind, potenzielle Komplikationen zu behandeln.

Abstract

Epidural spinal cord stimulation (SCS) is a reversible but invasive procedure which should be used for neuropathic pain, e.g. complex regional pain syndrome I (CRPS) and for mostly chronic radiculopathy in connection with failed back surgery syndrome following unsuccessful conservative therapy. Epidural SCS can also successfully be used after exclusion of curative procedures and conservative therapy attempts for vascular-linked pain, such as in peripheral arterial occlusive disease stages II and III according to Fontaine and refractory angina pectoris. Clinical practice has shown which clinical symptoms cannot be successfully treated by epidural SCS, e.g. pain in complete paraplegia syndrome or atrophy/injury of the sensory pathways of the spinal cord or cancer pain. A decisive factor is a critical patient selection as well as the diagnosis. Epidural SCS should always be used within an interdisciplinary multimodal therapy concept. Implementation should only be carried out in experienced therapy centers which are in a position to deal with potential complications.

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Author information

Authors and Affiliations

  1. Neurochirurgische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    V. Tronnier

  2. Sektion Neurologische Schmerzforschung und -therapie, Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland

    R. Baron

  3. Neurologische Klinik und interdisziplinäres Schmerztherapiezentrum, Universitätsmedizin Mainz, Mainz, Deutschland

    F. Birklein

  4. Klinik für Kardiologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland

    S. Eckert & D. Horstkotte

  5. Praxis für Schmerztherapie, Krefeld, Deutschland

    H. Harke

  6. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Knappschaftskrankenhaus Bocholt, Bocholt, Deutschland

    P. Hügler

  7. Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland

    M. Hüppe

  8. Schmerztherapiezentrum am Rothenbaum, Hamburg, Deutschland

    B. Kniesel

  9. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland

    C. Maier

  10. Abteilung für Anästhesiologie und Intensivmedizin, Marienhospital Letmathe, Letmathe, Deutschland

    G. Schütze

  11. Algesiologikum München, München, Deutschland

    R. Thoma

  12. Lehrstuhl für Neurophysiologie, Zentrum für Biomedizin und Medizintechnik Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Heidelberg, Deutschland

    R.D. Treede

  13. Neurochirurgische Praxis in der Tagesklinik Heilbronn, Heilbronn, Deutschland

    V. Vadokas

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Correspondence to V. Tronnier.

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Ein Erratum zu diesem Beitrag ist unter http://dx.doi.org/10.1007/s00482-011-1128-y zu finden.

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Tronnier, V., Baron, R., Birklein, F. et al. Epidurale Rückenmarkstimulation zur Therapie chronischer Schmerzen. Schmerz 25, 484–492 (2011). https://doi.org/10.1007/s00482-011-1094-4

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