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DOI: 10.1055/s-0037-1620098
Lumbaler Bandscheibenvorfall
Lumbar disc herniationPublication History
Publication Date:
24 December 2017 (online)
Zusammenfassung
Der lumbale Bandscheibenvorfall ist eine der häufigsten Erkrankungen der Lendenwirbelsäule. Der Vorfall provoziert eine schmerzhafte Nervenwurzelkompression im Spinalkanal mit gegebenenfalls auch neurologischen Defiziten. Eine genaueste Abklärung der Pathologie ist unabdingbar, um eine adäquate und effiziente Therapie in die Wege leiten zu können. Nur in Ausnahmefällen ist initial eine operative Therapie notwendig. Zuerst muss die konservative Therapie ausgeschöpft werden. Bei Therapieresistenz muss jedoch die Behandlung regelmäßig hinterfragt werden, um nicht in eine Chronizität der Schmerzphase zu gelangen. Bei adäquater Indikation zur Operation kann man mit einer Erfolgsrate von bis zu 90 Prozent rechnen, wissend, dass die Operation nachgewiesenermaßen zu einer rascheren Erho-lung von invalidisierenden Schmerzen führt als die konservativen Therapien. Ein Therapiealgorithmus kann helfen, zum richtigen Zeitpunkt die beste Therapieoption zu wählen.
Summary
Lumbar disc prolapse is one of the most common disorders of the lumbar spine. The prolapse causes painful nerve root compression in the spinal canal, sometimes with neurological deficits. Thorough investigation of the condition is essential to allow the initiation of appropriate and effective treatment. Only in exceptional cases surgical management is necessary in the early stages. The conservative therapeutic options should first be exhausted. Cases that remain refractory to treatment, however, should be reviewed regularly to avoid transition to the chronic pain phase. Where surgery is properly indicated, a success rate of up to 90 % can be expected, bearing in mind that this approach demonstrably leads to a more rapid recovery from disabling pain than the conservative management options. A treatment algorithm can assist in selection of the best therapeutic option at any particular time.
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