Z Orthop Unfall 2019; 157(04): 417-425
DOI: 10.1055/a-0767-7428
Review/Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Injektionstherapie, Katheter und Denervation beim spezifischen Rückenschmerz – was ist bewiesen?

Article in several languages: English | deutsch
Andreas Veihelmann
1   Department Wirbelsäule, Sportklinik Stuttgart GmbH
2   Orthopädie, SRH-Gesundheitszentrum Bad Herrenalb
3   Orthopädie, Ludwigs-Maximilians-Universität, München
› Author Affiliations
Further Information

Publication History

Publication Date:
27 November 2018 (online)

Zusammenfassung

Hintergrund Wirbelsäulennahe Injektion werden bei unterschiedlichen spezifischen Ursachen für akuten oder auch chronischen Rücken- und/oder Beinschmerz häufig durchgeführt. Auch wenn diese Injektionen und Kathetertherapieen in zahlreichen Leitlinien als Teil der konservativen Therapie implementiert sind, werden diese nach wie vor kontrovers diskutiert. Gerade wegen der unterschiedlichen Ansichten bez. einer gesteigerten Operationszahl bei degenerativen Veränderungen der Wirbelsäule in Deutschland rückt die konservative Therapie inklusive wirbelsäulennaher Injektionen in den Fokus von Wissenschaft und Forschung.

Methoden Dieser Artikel ist ein narrativer Review und soll einen breiten Überblick zur minimalinvasiven Behandlung des spezifischen Rückenschmerzes mittels Injektionen, Katheterbehandlungen und Denervation der Facettengelenke geben und über den aktuellen Forschungsstand informieren. Die Auswahl der berücksichtigten Artikel erfolgte nach Literaturanalyse via Medline und PubMed sowie der Cochrane-Database.

Ergebnisse Es gibt unterschiedliche Formen von bildgesteuerten Injektionstechniken sowie weitere Interventionsverfahren an der Wirbelsäule, die als schmerztherapeutische Maßnahmen beschrieben und in ihrer Wirksamkeit belegt sind. Lokale Injektionen der Facettengelenke beim Facettensyndrom und der Bandscheiben beim diskogenen Schmerz scheinen einen lediglich kurzfristigen Effekt zu haben, während epidurale Injektionen bei Diskusprolaps und/oder epiduraler Fibrose nach Wirbelsäulenoperationen (Postnukleotomiesyndrom) eine sinnvolle Unterstützung bei der konservativen Therapie leisten können. Auch epidurale Kathetertherapien können hier mittel- bis langfristige Schmerzreduktion herbeiführen. Beim Facettensyndrom scheint die Denervation mittels Radiofrequenz eine effektive Behandlungsmethode für eine kurz- bis mittelfristige Besserung darzustellen. Die Medikamente und das Steroidpräparat für wirbelsäulennahe Injektionen müssen sorgfältig ausgewählt werden. Sie werden in Deutschland i. d. R. als Off-Label-Use eingesetzt, worüber der Patient aufgeklärt werden muss und was nicht zulasten der gesetzlichen Krankenkassen abgerechnet werden darf.

 
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