Differenzialdiagnostik manualmedizinischer Syndrome bei unteren Rückenschmerzen unter Einbeziehung osteopathischer Verfahren

Zusammenfassung

Die differenzialdiagnostische Beurteilung schmerzhafter funktioneller Störungen der lumbosakralen und lumbopelvinen Region, also des sog. „unteren Rückenschmerzes“ ist sehr weit gespannt, wird jedoch häufig auf die Frage einer Chronifizierung reduziert. Die manualmedizinische Diagnostik kann hier einen wertvollen Beitrag in der Abgrenzung von struktureller und funktioneller Pathologie leisten. Frühzeitige manualmedizinische therapeutische Maßnahmen scheinen für perakute Beschwerden effektiv zu sein. Die Mobilisation funktioneller Störungen der viszeralen Aufhängungen im kleinen Becken sollte dabei einbezogen werden. Im folgenden Beitrag werden manualmedizinische Syndrome vorgestellt, die Befundhäufungen aus dem muskuloskelettalen und viszeralen System zusammenfassen. Das erleichtert die primäre differenzialdiagnostische Beurteilung, ebenso aber auch die Therapieplanung. Die Kombination mit den osteopathischen Verfahren ist dabei sehr gewinnbringend. Eine notwendige fachärztliche Differenzialdiagnostik bleibt unumgänglich.

Abstract

The differential diagnostic evaluation of painful functional disorders of the lumbosacral and lumbopelvic region, i.e. the so-called “low back pain” is very extensive, but is often reduced to the question of chronicity. The manual medical diagnosis can make a valuable contribution in such cases for determination of structural and functional pathology. Early application of manual medical therapies seems to be effective for peracute complaints. The mobilization of restrictions of the pelvic visceral attachments should be included. In the following review manual medical syndromes are presented that summarize the findings from the musculoskeletal and visceral system. This is intended to facilitate the primary differential diagnostic evaluation, as well as treatment planning. The combination with osteopathic methods is very profitable. A necessary specialist differential diagnosis remains essential.

Schlüsselwörter

Rückenschmerz - Unterbauchschmerz - Leistenschmerz - Verkettung - osteopathische Verfahren - dorsales lumbosakrales Syndrom - lumbopelvines Syndrom

Keywords

low back pain - abdominal pain - groin pain - concatenation - osteopathic methods - dorsal lumbosacral syndrome - lumbopelvic syndrome

Literatur

• 1 Wasiak R, Kim J, Pransky G. Work disability and costs caused by recurrence of low back pain: longer and more costly than in first episodes.  Spine. 2006;  31 219-225
• 2 Bornkessel B. Back pain. Epidemiology, causes and treatment possibilities.  Med Monatsschr Pharm. 1995;  18 68-74
• 3 Battie M C, Videman T, Levalahti E et al. Heritability of low back pain and the role of disc degeneration.  Pain. 2007;  131 272-280
• 4 Ochsmann E, Ruger H, Kraus T et al. Gender-specific risk factors for acute low back pain: starting points for target-group-specific prevention.  Schmerz. 2009;  23 377-384
• 5 Gobel H. Epidemiology and costs of chronic pain syndromes exemplified by specific and unspecific low back pain.  Schmerz. 2001;  15 92-98
• 6 Ricci J A, Stewart W F, Chee E et al. Back pain exacerbations and lost productive time costs in United States workers.  Spine. 2006;  31 3052-3060
• 7 Lahiri S, Gold J, Levenstein C. Estimation of net-costs for prevention of occupational low back pain: three case studies from the US.  Am J Ind Med. 2005;  48 530-541
• 8 Sturm A, Zidek W Hrsg. Differenzialdiagnose Innere Medizin.. 1. Aufl. Stuttgart, New York: Thieme; 2003
• 9 Zenz M. Back pain. Many questions and still too few answers.  Schmerz. 2007;  21 199-201
• 10 Asche C V, Kirkness C S, McAdam-Marx C et al. The societal costs of low back pain: data published between 2001 and 2007.  J Pain Palliat Care Pharmacother. 2007;  21 25-33
• 11 Mapel D W, Shainline M, Paez K et al. Hospital, pharmacy, and outpatient costs for osteoarthritis and chronic back pain.  J Rheumatol. 2004;  31 573-583
• 12 Carey T S, Garrett J, Jackman A et al. The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project.  N Engl J Med. 1995;  333 913-917
• 13 Buchner M, Neubauer E, Barie A et al. Comorbidity in patients with chronic low back pain.  Schmerz. 2007;  21 218-225
• 14 Brantingham J W, Adams K J, Cooley J R et al. A single-blind pilot study to determine risk and association between navicular drop, calcaneal eversion, and low back pain.  J Manipulative Physiol Ther. 2007;  30 380-385
• 15 Panjabi M M. A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction.  Eur Spine J. 2006;  15 668-676
• 16 Sachse J. Constitutional hypermobility as a problem in the rehabilitation of „vertebragenous“ pain syndromes.  Psychiatr Neurol Med Psychol. 1983;  35 629-633
• 17 Schmidt C O, Raspe H, Pfingsten M et al. Back pain in the German adult population: prevalence, severity, and sociodemographic correlates in a multiregional survey.  Spine. 2007;  32 2005-2011
• 18 Irving D B, Cook J L, Young M A et al. Obesity and Pronated Foot Type May Increase the Risk of Chronic Plantar Heel Pain: A Matched Case-Control Study: 814: June 1 8:45 AM–9:00 AM.  Med Sci Sports Exerc. 2007;  39 (S 05) S69
• 19 Gandjour A, Telzerow A, Lauterbach K W. European comparison of costs and quality in the treatment of acute back pain.  Spine. 2005;  30 969-975
• 20 Andersson G B, Lucente T, Davis A M et al. A comparison of osteopathic spinal manipulation with standard care for patients with low back pain.  N Engl J Med. 1999;  341 1426-1431
• 21 Luijsterburg P A, Verhagen A P, Ostelo R W et al. Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review.  Eur Spine J. 2007;  16 881-899
• 22 Licciardone J C, Stoll S T, Fulda K G et al. Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial.  Spine. 2003;  28 1355-1362
• 23 Buchmann J, Weber K. Weiche Techniken in der Manuellen Medizin.. 2. Aufl. Stuttgart: Hippokrates; 1997
• 24 Woodhead T, Clough A. A Systematic Review of the Evidence for Manipulation in the Treatment of Low Back Pain.  J Orthopaedic Med. 2005;  27 99-121
• 25 Ferreira M L, Ferreira P H, Latimer J et al. Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: A randomized trial.  Pain. 2007;  131 31-37
• 26 van Geen J W, Edelaar M J, Janssen M et al. The long-term effect of multidisciplinary back training: a systematic review.  Spine. 2007;  32 249-255
• 27 Feuerstein M, Hartzell M, Rogers H L et al. Evidence-based practice for acute low back pain in primary care: patient outcomes and cost of care.  Pain. 2006;  124 140-149
• 28 Hay E M, Mullis R, Lewis M et al. Comparison of physical treatments versus a brief pain-management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice.  Lancet. 2005;  365 2024-2030
• 29 Malmivaara A, Hakkinen U, Aro T et al. The treatment of acute low back pain – bed rest, exercises, or ordinary activity?.  N Engl J Med. 1995;  332 351-355
• 30 Mesrian A, Neubauer E, Schiltenwolf M. Reduction in pain intensity after treatment for chronic back pain. When is it clinically meaningful?.  Schmerz. 2007;  21 212, 214-217
• 31 Balague F, Mannion A F, Pellise F et al. Clinical update: low back pain.  Lancet. 2007;  369 726-728
• 32 Hancock M J, Maher C G, Latimer J et al. Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial.  Lancet. 2007;  370 1638-1643
• 33 Koes B W. Evidence-based management of acute low back pain.  Lancet. 2007;  370 1595-1596
• 34 Critchley D J, Ratcliffe J, Noonan S et al. Effectiveness and cost-effectiveness of three types of physiotherapy used to reduce chronic low back pain disability: a pragmatic randomized trial with economic evaluation.  Spine. 2007;  32 1474-1481
• 35 Bjordal J M, Johnson M I, Lopes-Martins R A et al. Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials.  BMC Musculoskeletal Disord. 2007;  8 51
• 36 Wagner E, Ehrenhofer B, Lackerbauer E et al. Rehabilitation of non-specific low back pain. Results of a multidisciplinary in-patient program.  Schmerz. 2007;  21 226, 228-233
• 37 Carette S, Marcoux S, Truchon R et al. A controlled trial of corticosteroid injections into facet joints for chronic low back pain.  N Engl J Med. 1991;  325 1002-1007
• 38 Deyo R A, Walsh N E, Martin D C et al. A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain.  N Engl J Med. 1990;  322 1627-1634
• 39 Tachihara H, Sekiguchi M, Kikuchi S et al. Do corticosteroids produce additional benefit in nerve root infiltration for lumbar disc herniation?.  Spine. 2008;  33 743-747
• 40 Armon C, Argoff C E, Samuels J et al. Assessment: use of epidural steroid injections to treat radicular lumbosacral pain: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.  Neurology. 2007;  68 723-729
• 41 Landau W M, Nelson D A, Armon C et al. Assessment: use of epidural steroid injections to treat radicular lumbosacral pain: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.  Neurology. 2007;  69 614 author reply 615
• 42 Gagnier J J, van Tulder M W, Berman B et al. Herbal medicine for low back pain: a Cochrane review.  Spine. 2007;  32 82-92
• 43 Vas J, Perea-Milla E, Mendez C et al. Efficacy and safety of acupuncture for chronic uncomplicated neck pain: a randomised controlled study.  Pain. 2006;  126 245-255
• 44 Vas J, Perea-Milla E, Mendez C et al. Efficacy and safety of acupuncture for the treatment of non-specific acute low back pain: a randomised controlled multicentre trial protocol [ISRCTN65814467].  BMC Complement Altern Med. 2006;  6 14
• 45 Khoromi S, Cui L, Nackers L et al. Morphine, nortriptyline and their combination vs. placebo in patients with chronic lumbar root pain.  Pain. 2007;  130 66-75
• 46 Gibson J N, Waddell G. Surgical interventions for lumbar disc prolapse: updated Cochrane Review.  Spine. 2007;  32 1735-1747
• 47 Anjarwalla N K, Brown L C, McGregor A H. The outcome of spinal decompression surgery 5 years on.  Eur Spine J. 2007;  16 1842-1847
• 48 Arts M P, Brand R, van den Akker M E et al. Tubular diskectomy vs conventional microdiskectomy for sciatica: a randomized controlled trial.  JAMA. 2009;  302 149-158
• 49 Everett C R, Patel R K. A systematic literature review of nonsurgical treatment in adult scoliosis.  Spine. 2007;  32 (S 19) S130-134
• 50 Trobisch P. Die idiopathische Skoliose.  Dtsch Arzetbl. 2010;  107 875-884
• 51 Yunus M B. Role of central sensitization in symptoms beyond muscle pain, and the evaluation of a patient with widespread pain.  Best Pract Res Clin Rheumatol. 2007;  21 481-497
• 52 Smart K M, Blake C, Staines A et al. The Discriminative validity of „nociceptive,“ „peripheral neuropathic,“ and „central sensitization“ as mechanisms-based classifications of musculoskeletal pain.  Clin J Pain. 2011;  27 655-663
• 53 Meeus M, Vervisch S, De Clerck L S et al. Central Sensitization in Patients with Rheumatoid Arthritis: A Systematic Literature Review.  Semin Arthritis Rheum. Epub Date 2011/11/01
• 54 Nielsen L A, Henriksson K G. Pathophysiological mechanisms in chronic musculoskeletal pain (fibromyalgia): the role of central and peripheral sensitization and pain disinhibition.  Best Pract Res Clin Rheumatol. 2007;  21 465-480
• 55 Staud R. Is it all central sensitization? Role of peripheral tissue nociception in chronic musculoskeletal pain.  Curr Rheumatol Rep. 2010;  12 448-454
• 56 Xu Y M, Ge H Y, Arendt-Nielsen L. Sustained nociceptive mechanical stimulation of latent myofascial trigger point induces central sensitization in healthy subjects.  J Pain. 2010;  11 1348-1355
• 57 Meeus M, Nijs J. Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome.  Clinical rheumatology. 2007;  26 465-473
• 58 Nilges P, Nagel B. What is chronic pain?.  Dtsch Med Wochenschr. 2007;  132 2133-2138
• 59 Conrad R, Schilling G, Bausch C et al. Temperament and character personality profiles and personality disorders in chronic pain patients.  Pain. 2007;  33 197-209
• 60 Gerbershagen H U, Panhans C. Organizational bases for management of chronic pain.  Klin Anasthesiol Intensivther. 1978;  18 251-255
• 61 Giesecke T, Gracely R H, Clauw D J et al. Central pain processing in chronic low back pain.  Evidence for reduced pain inhibition Schmerz. 2006;  20 411-414, 416–417
• 62 Ahacic K, Kareholt I. Prevalence of musculoskeletal pain in the general Swedish population from 1968 to 2002: age, period, and cohort patterns.  Pain. 2010;  151 206-214
• 63 Parsons S, Breen A, Foster N E et al. Prevalence and comparative troublesomeness by age of musculoskeletal pain in different body locations.  Fam Pract. 2007;  24 308-316
• 64 Soares J J, Sundin O, Grossi G. Age and musculoskeletal pain.  Int J Behav Med. 2003;  10 181-190
• 65 DePalma M J, Ketchum J M, Saullo T. What is the source of chronic low back pain and does age play a role?.  Pain Med. 2011;  12 224-233
• 66 Leboeuf-Yde C, Kyvik K O. At what age does low back pain become a common problem? A study of 29,424 individuals aged 12–41 years.  Spine (Phila Pa 1976). 1998;  23 228-234
• 67 Taimela S, Kujala U M, Salminen J J et al. The prevalence of low back pain among children and adolescents. A nationwide, cohort-based questionnaire survey in Finland.  Spine (Phila Pa 1976). 1997;  22 1132-1136
• 68 Balague F, Dudler J, Nordin M. Low-back pain in children.  Lancet. 2003;  361 1403-1404
• 69 El-Metwally A, Mikkelsson M, Stahl M et al. Genetic and environmental influences on non-specific low back pain in children: a twin study.  Eur Spine J. 2008;  17 502-508
• 70 Newcomer K, Sinaki M. Low back pain and its relationship to back strength and physical activity in children.  Acta Paediatr. 1996;  85 1433-1439
• 71 Salminen J J, Oksanen A, Maki P et al. Leisure time physical activity in the young. Correlation with low-back pain, spinal mobility and trunk muscle strength in 15-year-old school children.  Int J Sports Med. 1993;  14 406-410
• 72 Harreby M, Nygaard B, Jessen T et al. Risk factors for low back pain in a cohort of 1389 Danish school children: an epidemiologic study.  Eur Spine J. 1999;  8 444-450
• 73 Plouvier S, Gourmelen J, Chastang J F et al. Low back pain around retirement age and physical occupational exposure during working life.  BMC Public Health. 2011;  11 268
• 74 Buchner M, Neubauer E, Zahlten-Hinguranage A et al. Age as a predicting factor in the therapy outcome of multidisciplinary treatment of patients with chronic low back pain – a prospective longitudinal clinical study in 405 patients.  Clinical rheumatology. 2007;  26 385-392
• 75 Paajanen H, Erkintalo M, Parkkola R et al. Age-dependent correlation of low-back pain and lumbar disc regeneration.  Archives of orthopaedic and trauma surgery. 1997;  116 106-107
• 76 Janda V. Manuelle Muskelfunktionsdiagnostik.. 4. Aufl. München, Jena: Urban & Fischer; 2000
• 77 Kim H W, Ko Y J, Rhee W I et al. Interexaminer reliability and accuracy of posterior superior iliac spine and iliac crest palpation for spinal level estimations.  J Manipulative Physiol Ther. 2007;  30 386-389
• 78 Roussel N A, Nijs J, Truijen S et al. Low back pain: clinimetric properties of the Trendelenburg test, active straight leg raise test, and breathing pattern during active straight leg raising.  J Manipulative Physiol Ther. 2007;  30 270-278
• 79 Lewit K, Kobesova A, Lepsikova M. Das tiefe stabilisierende System der Wirbelsäule. Seine Bedeutung für funktionelles Denken.  Man Med. 2010;  6 440-446
• 80 Meert G F. Das Becken aus osteopathischer Sicht.. 2. Aufl. München: Urban & Fischer, Elsevier; 2006
• 81 Paoletti S. Faszien.. 1. Aufl. München, Jena: Urban & Fischer; 1998
• 82 Richter P, Hebgen E. Triggerpunkte und Muskelfunktionsketten in der Osteopathie und Manuellen Therapie.. 1. Aufl. Stuttgart: Hippokrates; 2006
• 83 Myers T W. Anatomy Trains.. 2. Aufl. München: Urban & Fischer; 2004
• 84 Struyff-Denys G. Les chaines musculaires et articulaires.. 1. Aufl. Paris: ICTGDS; 1979
• 85 Tittel K. Beschreibende und funktionelle Anatomie des Menschen.. 12. Aufl. Jena, Stuttgart: Gustav Fischer; 1994
• 86 Müller R, Linz W, Buchmann J. Gekonnte Handgriffe bei Blockaden, Verspannungen udn Schiefstand.  MMW. 2011;  153 27-30
• 87 Müller R, Linz W, Buchmann J. Behandlungskonzept bei lumbalen Rückenschmerzen – Ist der Rumpf stabil, bessern sich die Beschwerden.  MMW. 2011;  153 31-35
• 88 Barral J-P, Mercier P. Lehrbuch der viszeralen Osteopathie 1.. 1. Aufl. München: Urban & Fischer; 2005
• 89 Barral J-P, Mercier P. Lehrbuch der viszeralen Osteopathie 2.. 1. Aufl. München: Urban & Fischer; 2005
• 90 Helsmoortel J, Hirth T, Wührl P. Lehrbuch der viszeralen Osteopathie. Peritoneale Organe.. 1. Aufl. Stuttgart, New York: Thieme; 2002
• 91 Lewit K. Manuelle Medizin.. 7. Aufl. Leipzig, Heidelberg: Johann Ambrosius Barth; 2006
• 92 Littlejohn J M. The Pathology of the Osteopathic Lesion.. 1. Aufl. Indianapolis: Maidstone College of Osteopathy, AAO Yearbook; 1977
• 93 Butler D S, Jones M A. Mobilisation des Nervensystems.. 1. Aufl. Berlin: Springer; 1995
• 94 Ludwig J, Tiedjen K, Krämer J. Klinische Krankheitbilder der LWS.. In: Krämer J, Hrsg Wirbelsäule.. 1. Aufl. Stuttgart: Thieme; 2004: 297-301
• 95 Brügger A. Das sternale Syndrom.. 1. Aufl. Bern: Huber; 1974
• 96 Freynhagen R, Rolke R, Baron R et al. Pseudoradicular and radicular low-back pain – a disease continuum rather than different entities? Answers from quantitative sensory testing.  Pain. 2008;  135 65-74
• 97 Rohde J. Die funktionelle Instabilität des Knie- und oberen Sprunggelenkes bei lumbalem Radikulärsyndrom.  Man Med. 2008;  46 228-237
• 98 Krämer J. Bandscheibenbedingte Erkrankungen.. 2. Aufl. Stuttgart: Thieme; 1997
• 99 Kayser R, Mahlfeld K, Heyde C E. Das Konzept der stationären Stufendiagnostik bei Patienten mit lumbalem Rückenschmerz.  Orthopäde. 2008;  37 285-299
• 100 Mumenthaler M, Schliack H. Läsionen peripherer Nerven.. 2. Aufl. Stuttgart: Thieme; 1993
• 101 Kuhlendahl H, Hensell V. Median mass prolapse of lumbar ligament disks with cauda compression.  Dtsch Med Wochenschr. 1953;  78 332-343
• 102 Golder W. Phraseology of disk herniation: an inevitable revision renaming the posterior disk prolapse – retrolapse is better.  Fortschr Neurol Psychiatr. 2010;  78 479-480
• 103 Krämer J, Köster O. MRT-Atlas der Lendenwirbelsäule.. 1. Aufl. Stuttgart: Thieme; 2001
• 104 Madl M, Linhardt O, Boluki D et al. Minimally invasive injection therapy for patients with radicular lumbar spine syndrome. First results of an minimally invasive treatment for patients with lumbar radiculopathy.  Schmerz. 2007;  21 445-452
• 105 Hildebrandt J. Invasive diagnostische Verfahren durch Blockaden und provokationsradiologische Maßnahmen.. In: Hildebrandt J, Müller G, Pfingsten M, Hrsg Lendenwirbelsäule.. 1. Aufl. München: Elvesier; 2005: 282-298
• 106 Boswell M V, Shah R V, Everett C R et al. Interventional techniques in the management of chronic spinal pain: evidence-based practice guidelines.  Pain physician. 2005;  8 1-47
• 107 Buenaventura R M, Shah R V, Patel V et al. Systematic review of discography as a diagnostic test for spinal pain: an update.  Pain physician. 2007;  10 147-164
• 108 McMorland G, Suter E, Casha S et al. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study.  J Manipulative Physiol Ther. 2010;  33 576-584
• 109 Ghormley R K. Low back pain with special reference to the articular facets with presentation of an operative procedure.  JAMA. 1933;  101 1773-1775
• 110 Mooney V, Robertson J. The facet syndrome.  Clin Orthop Relat Res. 1976;  115 149-156
• 111 Schwarzer A C, Aprill C N, Derby R et al. The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints.  Pain. 1994;  58 195-200
• 112 Hildebrandt J. Mechanische, nicht radikuläre Schmerzen.. In: Hildebrandt J, Müller G, Pfingsten M, Hrsg Lendenwirbelsäule.. 1. Aufl. München: Elsevier; 2005: 598-610
• 113 Revel M, Poiraudeau S, Auleley G R et al. Capacity of the clinical picture to characterize low back pain relieved by facet joint anesthesia. Proposed criteria to identify patients with painful facet joints.  Spine. 1998;  23 1972-1976; discussion 7
• 114 Theodoridis T, Krämer J. Injektionstherapie an der Wirbelsäule. Manual und Atlas.. 2. Aufl. Stuttgart, New York: Thieme; 2007
• 115 Sehgal N, Dunbar E E, Shah R V et al. Systematic review of diagnostic utility of facet (zygapophysial) joint injections in chronic spinal pain: an update.  Pain physician. 2007;  10 213-228
• 116 Henschke N, Kuijpers T, Rubinstein S M et al. Injection therapy and denervation procedures for chronic low-back pain: a systematic review.  Eur Spine J. 2010;  19 1425-1449
• 117 Paoloni M, Di Sante L, Cacchio A et al. Intramuscular oxygen-ozone therapy in the treatment of acute back pain with lumbar disc herniation: a multicenter, randomized, double-blind, clinical trial of active and simulated lumbar paravertebral injection.  Spine (Phila Pa 1976). 2009;  34 1337-1344
• 118 Kayser R. Experimentelle Untersuchungen zur Instabilität der lumbalen Wirbelsäule [Habilitationsschrift].. Greifswald: Universität; 2005
• 119 White A A, Panjabi M M. Clinical biomechanics of the spine.. Philadelphia, Baltimore, Tokyo: Lippincott Williams & Wilkens; 1990
• 120 Stork H. Contracture of the lumbar spine and its relationship to body bearing and movement.  Verh Dtsch Orthop Ges. 1935;  62 102-107
• 121 Matzen P F, Polster J. Der Symptomenkomplex der „Hüft-Lenden-Strecksteife“.  Arch Orthop Unfall-Chirur. 1960;  51 399-409
• 122 Kayser R, Mahlfeld K, Heyde C E et al. Tight hamstring syndrome and extra- or intraspinal diseases in childhood: a multicenter study.  Eur Spine J. 2006;  15 403-408
• 123 Buchmann J. Kraniosakrale Therapie – Fiktion oder Möglichkeit?.  Man Med. 2007;  45 21-25
• 124 Heymann W v, Kours S. Was ist der „kraniosakrale Rhythmus“? Ein Beitrag zum Umgang mit der „kraniosakralen Osteopathie“ (CSO).  Man Med. 2006;  44 117-184
• 125 Simotas A C, Dorey F J, Hansraj K K et al. Nonoperative treatment for lumbar spinal stenosis. Clinical and outcome results and a 3-year survivorship analysis.  Spine. 2000;  25 197-203; discussions-4
• 126 Koc Z, Ozcakir S, Sivrioglu K et al. Effectiveness of physical therapy and epidural steroid injections in lumbar spinal stenosis.  Spine (Phila Pa 1976). 2009;  34 985-989
• 127 Richter M, Kluger P, Puhl W. Diagnosis and therapy of spinal stenosis in the elderly.  Z Orthop Ihre Grenzgeb. 1999;  137 474-481
• 128 Thome C, Börm W, Meyer F. Die degenerative lumbale Spinalkanalstenose.  Dtsch Arzetbl. 2008;  105 373-379
• 129 Atlas S J, Keller R B, Robson D et al. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study.  Spine. 2000;  25 556-562
• 130 Malmivaara A, Slatis P, Heliovaara M et al. Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial.  Spine. 2007;  32 1-8
• 131 Weinstein J N, Tosteson T D, Lurie J D et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis.  N Engl J Med. 2008;  358 794-810
• 132 Weinstein J N, Tosteson T D, Lurie J D et al. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial.  Spine (Phila Pa 1976). 2010;  35 1329-1338
• 133 Chou R, Atlas S J, Stanos S P et al. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline.  Spine (Phila Pa 1976). 2009;  34 1078-1093
• 134 Chou R, Baisden J, Carragee E J et al. Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline.  Spine (Phila Pa 1976). 2009;  34 1094-1109
• 135 Chou R, Loeser J D, Owens D K et al. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society.  Spine (Phila Pa 1976). 2009;  34 1066-1077
• 136 Tronnier V M, Rasche D. Neuroablative procedures in pain therapy.  Schmerz. 2009;  23 531-541
• 137 Brotz D, Maschke E, Burkard S et al. Is there a role for benzodiazepines in the management of lumbar disc prolapse with acute sciatica?.  Pain. 2010;  149 470-475
• 138 Kotecha A K, Mofidi A, Morgan-Hough C et al. Coccygectomy for coccygodynia: do we really have to wait?.  Injury. 2008;  39 816-817 author reply 7–8
• 139 Sehirlioglu A, Ozturk C, Oguz E et al. Coccygectomy in the surgical treatment of traumatic coccygodynia.  Injury. 2007;  38 182-187
• 140 Cebesoy O, Guclu B, Kose K C et al. Coccygectomy for coccygodynia: do we really have to wait?.  Injury. 2007;  38 1183-1188
• 141 Pennekamp P H, Kraft C N, Stutz A et al. Coccygectomy for coccygodynia: does pathogenesis matter?.  J Trauma. 2005;  59 1414-1419
• 142 Tilscher H, Kantor H, Gangl W et al. Coccygodynia – a diagnostic and therapeutic problem in orthopedics.  Z Orthop Ihre Grenzgeb. 1986;  124 628-632
• 143 Niethard F U, Pfeil J. Orthopädie.. 2. Aufl. Stuttgart: Hippokrates; 1997
• 144 Ramsey M L, Toohey J S, Neidre A et al. Coccygodynia: treatment.  Orthopedics. 2003;  26 403-405; discussion 5
• 145 Schops P, Seeger D. Physicomedical therapy of acute and chronic pain.  Schmerz. 2009;  23 191-212
• 146 De Andres J, Chaves S. Coccygodynia: a proposal for an algorithm for treatment.  J Pain. 2003;  4 257-266
• 147 Renker E K, Schluter J, Neubauer E et al. Therapy of patients with chronic back pain. Prescriptions – contentment – outcome.  Schmerz. 2009;  23 284-291
• 148 Tilscher H. Low back pain: diagnosis and conservative therapy from the orthopedic viewpoint.  Anasthesiol Intensivmed Notfallmed Schmerzther. 1998;  33 795-798
• 149 Cohen S P. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment.  Anesth Analg. 2005;  101 1440-1453
• 150 Bischoff H P. Sakroiliakalgelenk.. In: Wirth C J, Hrsg Praxis der Orthopädie.. 1. Aufl. Stuttgart: Thieme; 2001: 543-545
• 151 Vleeming A, Mooney V, Dorman T et al. Movement, stability and low back pain. The essential role of the pelvis.. New York: Churchill Livingstone; 2000
• 152 Torstensson T, Lindgren A, Kristiansson P. Corticosteroid injection treatment to the ischiadic spine reduced pain in women with long-lasting sacral low back pain with onset during pregnancy: a randomized, double blind, controlled trial.  Spine (Phila Pa 1976). 2009;  34 2254-2258
• 153 Bachmann S, Mietzsch T. Kreuzschmerzen – Abklärung und Behandlung aus rheumatologisch-internistischer Sicht.  Phys Med Rehab Kur Med. 2010;  20 41-56
• 154 Joss A W, Mavin S, Ho-Yen D O. Increased incidence of Lyme borreliosis following mild winters and during warm, humid summers.  Eur J Clin Microbiol Infect Dis. 2007;  26 79
• 155 Herzer P. Lyme-Borreliose.. 1. Aufl. Darmstadt: Steinkopff; 1989
• 156 Pigrau C, Almirante B, Flores X et al. Spontaneous pyogenic vertebral osteomyelitis and endocarditis: incidence, risk factors, and outcome.  Am J Med. 2005;  118 1287
• 157 Mulleman D, Philippe P, Senneville E et al. Streptococcal and enterococcal spondylodiscitis (vertebral osteomyelitis). High incidence of infective endocarditis in 50 cases.  J Rheumatol. 2006;  33 91-97
• 158 Sobottke R, Seifert H, Fätkenheuer G et al. Aktuelle Diagnostik und Therapie der Spondylodiszitis.  Dtsch Arzetbl. 2008;  105 181-187
• 159 Fernandez-de-Las-Penas C, Alonso-Blanco C, Alguacil-Diego I M et al. One-year follow-up of two exercise interventions for the management of patients with ankylosing spondylitis: a randomized controlled trial.  Am J Phys Med Rehabil. 2006;  85 559-567
• 160 Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients.  Neurosurg Rev. 2000;  23 175-204; discussion 5
• 161 Kastenbauer S, Pfister H-W. Intrakranielle und spinale Abszesse.. In: Brandt T, Dichgans J, Diener H C, Hrsg Therapie und Verlauf neurologischer Erkrankungen.. 5. Aufl. Stuttgart: Kohlhammer; 2007
• 162 Bartels R H, de Jong T R, Grotenhuis J A. Spinal subdural abscess. Case report.  J Neurosurg. 1992;  76 307-311
• 163 Chan C T, Gold W L. Intramedullary abscess of the spinal cord in the antibiotic era: clinical features, microbial etiologies, trends in pathogenesis, and outcomes.  Clin Infect Dis. 1998;  27 619-626
• 164 Prange H. Infektionskrankheiten des ZNS.. 1. Aufl. Weinheim: Chapman & Hall; 1995
• 165 Ragonese P, Fierro B, Salemi G et al. Prevalence and risk factors of post-polio syndrome in a cohort of polio survivors.  J Neurol Sci. 2005;  236 31-35
• 166 Alamanos Y, Voulgari P V, Drosos A A. Incidence and prevalence of psoriatic arthritis: a systematic review.  J Rheumatol. 2008;  35 1354-1358
• 167 Salvador de la Barrera S, Barca-Buyo A, Montoto-Marques A et al. Spinal cord infarction: prognosis and recovery in a series of 36 patients.  Spinal Cord. 2001;  39 520-525
• 168 Luft A R, Nelles G, Haumann G F. Spinale Durchblutungsstörungen.. In: Brandt T, Dichgans J, Diener H C, Hrsg Therapie und Verlauf neurologischer Erkrankungen.. 5. Aufl. Stuttgart: Kohlhammer; 2007
• 169 Azzarelli B, Roessmann U. Diffuse „anoxic“ myelopathy.  Neurology. 1977;  27 1049-1052
• 170 Huang T C, Hwang J J, Yip P K et al. Hypotensive spinal cord infarction associated with vertebral body infarction after treatment with short-acting antihypertensive agent.  J Formos Med Assoc. 2005;  104 607-610
• 171 Somayaji H S, Saifuddin A, Casey A T et al. Spinal cord infarction following therapeutic computed tomography-guided left L2 nerve root injection.  Spine. 2005;  30 E106-108
• 172 Castel E, Lazennec J Y, Chiras J et al. Acute spinal cord compression due to intraspinal bleeding from a vertebral hemangioma: two case-reports.  Eur Spine J. 1999;  8 244-248
• 173 Kim R C, Smith H R, Henbest M L et al. Nonhemorrhagic venous infarction of the spinal cord.  Annals of neurology. 1984;  15 379-385
• 174 Wick W, Weller M. Meningeosis neoplastica.. In: Brandt T, Dichgans J, Diener H C, Hrsg Therapie und Verlauf neurologischer Erkrankungen.. 5. Aufl. Stuttgart: Kohlhammer; 2007
• 175 Roser F, Tatagiba M. Syringomyelie und Syringobulbi.. In: Brandt T, Dichgans J, Diener H C, Hrsg Therapie und Verlauf neurologischer Erkrankungen.. 5. Aufl. Stuttgart: Kohlhammer; 2007
• 176 Fahn S, Bressman S B, Marsden C D. Classification of dystonia.  Adv Neurol. 1998;  78 1-10
• 177 Schöls L, Asmus F. Dystonien und Dyskinesien.. In: Brandt T, Dichgans J, Diener H C, Hrsg Therapie und Verlauf neurologischer Erkrankungen.. 5. Aufl. Stuttgart: Kohlhammer; 2007
• 178 Garten H. Manuelle Therapie bei zervikaler Dystonie.  Man Med. 2008;  46 238-244
• 179 Lance J W. Symposium Synopsis.. In: Feldman R G, Young R R, Koella W P, Hrsg Spasticity: Disordered Motor Control.. Chicago: Year Book Publ; 1980: 485-495
• 180 Dietz W, Schöls L. Syndrom der spastischen Parese und spastische Spinalparalysen.. In: Brandt T, Dichgans J, Diener H C, Hrsg Therapie und Verlauf neurologischer Erkrankungen.. 5. Aufl. Stuttgart: Kohlhammer; 2007
• 181 Bovend’Eerdt T J, Newman M, Barker K et al. The effects of stretching in spasticity: a systematic review.  Arch Phys Med Rehabil. 2008;  89 1395-1406
• 182 Lohse-Busch H. Komplexbehandlung mit Manueller Medizin und Physiotherapie bei zerebral bewegungsgestörten Kindern.  Man Med. 2001;  39 72-78
• 183 Meinck H-M. Ungewöhnliche Formen zentraler motorischer Hyperaktivität: Spasmen, Startle- und Stiff-man-Syndrom.. In: Brandt T, Dichgans J, Diener H C, Hrsg Therapie und Verlauf neurologischer Erkrankungen.. 5. Aufl. Stuttgart: Kohlhammer; 2007
• 184 Meinck H M, Thompson P D. Stiff man syndrome and related conditions.  Mov Disord. 2002;  17 853-866
• 185 Topka H. Krampi.. In: Brandt T, Dichgans J, Diener H C, Hrsg Therapie und Verlauf neurologischer Erkrankungen.. 5. Aufl. Stuttgart: Kohlhammer; 2007
• 186 Walter M C, Pongratz D. Myositiden.. In: Brandt T, Dichgans J, Diener H C, Hrsg Therapie und Verlauf neurologischer Erkrankungen.. 5. Aufl. Stuttgart: Kohlhammer; 2007
• 187 Gerami P, Schope J M, McDonald L et al. A systematic review of adult-onset clinically amyopathic dermatomyositis (dermatomyositis sine myositis): a missing link within the spectrum of the idiopathic inflammatory myopathies.  J Am Acad Dermatol. 2006;  54 597-613
• 188 Miller A E, Davis B A, Beckley O A. Bilateral and recurrent myositis ossificans in an athlete: a case report and review of treatment options.  Arch Phys Med Rehabil. 2006;  87 286-290
• 189 Klopstock T, Pongratz D. Myopathien.. In: Brandt T, Dichgans J, Diener H C, Hrsg Therapie und Verlauf neurologischer Erkrankungen.. 5. Aufl. Stuttgart: Kohlhammer; 2007
• 190 Beesdo K, Bittner A, Pine D S et al. Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life.  Arch Gen Psychiatry. 2007;  64 903-912
• 191 Eich W, Hauser W, Friedel E et al. Definition, classification and diagnosis of fibromyalgia syndrome.  Schmerz. 2008;  22 255-266
• 192 Hauser W. Fibromyalgia syndrome: guideline principle for a fiction?.  Schmerz. 2008;  22 239-240
• 193 Eisenberg D M, Post D E, Davis R B et al. Addition of choice of complementary therapies to usual care for acute low back pain: a randomized controlled trial.  Spine. 2007;  32 151-158
• 194 Kuehn B M. Medical groups release new guidelines for treatment of low back pain.  JAMA. 2007;  298 2253
• 195 Bundesärztekammer KB, AWMF Hrsg. Nationale Versorgungsleitlinie zum Kreuzschmerz.  Dtsch Arztbl. 2010;  B2193-2196
• 196 Assendelft W J, Morton S C, Yu E I et al. Spinal manipulative therapy for low back pain.  Cochrane database Syst Rev 2004;  CD000447
• 197 Childs J D, Fritz J M, Flynn T W et al. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study.  Ann Intern Med. 2004;  141 920-928
• 198 Boxem K V, Zundert J V, van Kleef M et al. Injection therapy for subacute and chronic low-back pain. Cochrane Database Syst Rev 2008: CD001824.  Spine (Phila Pa 1976). 2009;  34 1628-1629; author reply 9
• 199 Staal J B, de Bie R A, de Vet H C et al. Injection therapy for subacute and chronic low back pain: an updated Cochrane review.  Spine (Phila Pa 1976) 2009;. 1;  34 49-59
• 200 Hopayian K, Song F, Riera R et al. The clinical features of the piriformis syndrome: a systematic review.  Eur Spine J. 2010;  19 2095-2109
• 201 Kirschner J S, Foye P M, Cole J L. Piriformis syndrome, diagnosis and treatment.  Muscle & nerve. 2009;  40 10-18
• 202 Reichel G. Das Piriformis-Syndrom – Diagnostik und Therapie.  Klin Neurophysiol. 2010;  41 203-217
• 203 Mannion A F, Denzler R, Dvorak J et al. A randomised controlled trial of post-operative rehabilitation after surgical decompression of the lumbar spine.  Eur Spine J. 2007;  16 1101-1117
• 204 Luijsterburg P A, Verhagen A P, Ostelo R W et al. Physical therapy plus general practitioners’ care versus general practitioners’ care alone for sciatica: a randomised clinical trial with a 12-month follow-up.  Eur Spine J. 2008;  17 509-517
• 205 Castro W HM, Schilgen M. Kreuzschmerzen. Ursachen, Behandlung, Vorbeugung.. 1. Aufl. Gütersloh: Bertelsmann Stiftung; 2003
• 206 Renner R, Simon J. Chronic venous insufficiency (CVI).  Dtsch Med Wochenschr. 2009;  134 2181-2190
• 207 Müller R. Behandlungskonzept lumbaler Rückenschmerzen in der Hausarztpraxis.  Man Med. 2009;  3 183-189
• 208 Wagner H, Puta C, Anders S et al. Chronischer unspezifischer Rückenschmerz.  Man Med. 2009;  47 39-51
• 209 Shirado O, Doi T, Akai M et al. Multicenter randomized controlled trial to evaluate the effect of home-based exercise on patients with chronic low back pain: the Japan low back pain exercise therapy study.  Spine (Phila Pa 1976). 2010;  35 E811-819
• 210 Sachse J, Schildt-Rudloff K. Wirbelsäule: Manuelle Untersuchung und Mobilisationsbehandlung.. 4. Aufl. München, Jena: Urban & Fischer; 2000
• 211 Calmels P, Queneau P, Hamonet C et al. Effectiveness of a lumbar belt in subacute low back pain: an open, multicentric, and randomized clinical study.  Spine (Phila Pa 1976). 2009;  34 215-220
• 212 Rasmussen-Barr E, Ang B, Arvidsson I et al. Graded exercise for recurrent low-back pain: a randomized, controlled trial with 6-, 12-, and 36-month follow-ups.  Spine (Phila Pa 1976). 2009;  34 221-228
• 213 Maetzler M, Bochdansky T, Cochrane L et al. Sensory Motor Training for Active Completion of Osteopathic Treatment.  Phys Med Rehab Kuror. 2008;  18 203-206
• 214 Kreis M E, Koch F Ev, Jauch K-W et al. Abklärung des rechtsseitigen Unterbauchschmerzes.  Dtsch Arztebl. 2007;  104 A3114-3121
• 215 Tilscher H, Bogner G, Landsiedl F. Visceral diseases as cause of lumbar syndromes.  Z Rheumatol. 1977;  36 161-167
• 216 Al-Khodairy A W, Bovay P, Gobelet C. Sciatica in the female patient: anatomical considerations, aetiology and review of the literature.  Eur Spine J. 2007;  16 721-731
• 217 Tilscher H, Eder M. Manuelle Medizin – Konservative Orthopädie: Vom Befund zur Behandlung.. 3. Aufl. Maudrich; 2008

1 † in ehrendem Gedenken.