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Z Orthop Unfall 2018; 156(05): 554-560
DOI: 10.1055/a-0586-4815
Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Management von akutem Kreuzschmerz ohne Trauma – ein Algorithmus

Managment of acute low back pain without trauma – an algorithm
Carolin Melcher
1   Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Ludwig-Maximilians-Universität München, Medizinische Fakultät
,
Bernd Wegener
1   Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Ludwig-Maximilians-Universität München, Medizinische Fakultät
,
Volkmar Jansson
1   Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Ludwig-Maximilians-Universität München, Medizinische Fakultät
,
Wolf Mutschler
2   Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie, Klinikum der Universität München
,
Karl-Georg Kanz
3   Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München
,
Christof Birkenmaier
1   Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Ludwig-Maximilians-Universität München, Medizinische Fakultät
› Author Affiliations
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Publication History

Publication Date:
14 May 2018 (online)

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Zusammenfassung

Hintergrund Rückenschmerzen stellen ein häufiges Problem in Allgemeinarztpraxen, Spezialambulanzen und chirurgischen Notaufnahmen dar. Überwiegend handelt es sich um sog. „unkomplizierte“ Rückenschmerzen, jedoch können sich schwerwiegende Pathologien hinter dem Symptomkomplex „Kreuzschmerz“ verbergen. Gerade für unerfahrene Kollegen bleibt die Behandlung trotz vielfältiger Empfehlungen und Leitlinien der Fachgesellschaften schwierig, da kaum übersichtliche und schnell einzusehende Handlungsalgorithmen existieren.

Methode In der Literaturrecherche (Medline/Cochrane) wurden aus 15 000 Veröffentlichungen 158 relevante Artikel selektiert und entsprechend ihres Evidenzgrades klassifiziert. Diese wurden mit den Guidelines der Fachgesellschaften für Orthopädie und Schmerztherapie aus Europa, Nordamerika und Übersee sowie Erfahrungswerten der Spezialisten der LMU München abgestimmt, um sowohl eine Übereinstimmung mit den Empfehlungen der Literatur als auch eine Durchführbarkeit im Alltag zu gewährleisten und eine hohe Praxisnähe zu erzielen.

Ergebnis Entstanden ist ein Algorithmus, welcher die entscheidenden Differenzialdiagnosen des akuten Kreuzschmerzes ihrer Priorität entsprechend bearbeitet und einen Handlungsablauf von diagnostischen Maßnahmen und therapeutische Schritten vorgibt. Durch klare binäre Entscheidungen und daraus resultierenden Anweisungen sollen Patienten mit akuten Kreuzschmerzen jederzeit von Kollegen entsprechend den zugrunde liegenden Leitlinien behandelt, Notfälle erkannt, nicht notwendige Untersuchungen und Interventionen vermieden und die für die jeweilige Pathologie sinnvollen therapeutischen Maßnahmen eingeleitet werden können.

Schlussfolgerung Im Kontext der verfügbaren Evidenz entwickelten wir einen klinischen Algorithmus, der die komplexe Diagnostik von akutem Kreuzschmerz in einen transparenten, systematischen und strukturierten Leitfaden umsetzt.

Abstract

Background Low back pain is a common problem for primary care providers, outpatient clinics and A&E departments. The predominant symptoms are those of so-called “unspecific back pain”, but serious pathologies can be concealed by the clinical signs. Especially less experienced colleagues have problems in treating these patients, as – despite the multitude of recommendations and guidelines – there is no generally accepted algorithm.

Methods After a literature search (Medline/Cochrane), 158 articles were selected from 15,000 papers and classified according to their level of evidence. These were attuned to the clinical guidelines of the orthopaedic and pain-physician associations in Europe, North America and overseas and the experience of specialists at LMU Munich, in order to achieve consistency with literature recommendations, as well as feasibility in everyday clinical work and optimised with practical relevance.

Results An algorithm was formed to provide the crucial differential diagnosis of lumbar back pain according to its clinical relevance and to provide a plan of action offering reasonable diagnostic and therapeutic steps. As a consequence of distinct binary decisions, low back patients should be treated at any given time according to the guidelines, with emergencies detected, unnecessary diagnostic testing and interventions averted and reasonable treatment initiated pursuant to the underlying pathology.

Conclusion In the context of the available evidence, a clinical algorithm has been developed that translates the complex diagnostic testing of acute low back pain into a transparent, structured and systematic guideline.

Schlüsselwörter

Rückenschmerzen - Diagnostik - Differenzialdiagnosen - Behandlungspfad - Therapie

Key words

back pain - diagnostics - differential diagnosis - algorithm - therapy
 

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