Lumbaler diskogener Schmerz - Bandscheibendegeneration und minimalinvasive Therapie

Lumbaler diskogener Schmerz ist verantwortlich für zahllose Arbeitsausfälle und verursacht Kosten in Millionenhöhe. In den letzten Jahren haben minimalinvasive Therapieverfahren deutlich an Akzeptanz gewonnen. Das jahrhundertealte Dilemma dieser Schmerzen ist dennoch bis heute nicht gelöst. Sicher ist nur: Diskogene Schmerzen haben viele Gründe. Aus dem Nucleus pulposus austretende biochemische Substanzen sind sicherlich für die Entstehung von Entzündungen und somit von Schmerz verantwortlich. Neuropeptide, freigesetzt von den peripheren Enden nozizeptiver afferenter Bahnen, sind Entzündungsmediatoren, also Schmerzerzeuger. Die den Diskus versorgenden Nerven sind mittlerweile bekannt und können mit guten Ergebnissen denerviert werden. Bei diesen Nerven von posterior nach anterior handelt es sich um die sinuvertebralen Nerven, die Rami communicantes und den Truncus sympathicus.

Discogenic pain has been responsible for a countless number of missed workdays and millions if not billions of dollars of lost revenue. Minimaly invasive interventional therapies of the discogenic back pain gained significant acceptance among the proceduralists. The centuries old dilemma of discogenic low back pain has by no means been answered. We know today that discogenic low back pain has a multitude of causes. The leaking „chemical soup” within the nucleus pulposus is certainly responsible for causing inflammation and thus pain. However, neuropeptides released from peripheral endings of nociceptive afferents are also inflammatory mediators and pain generators. The nerves innervating the discs have been identified and in many cases denervated with good results. These nerves from posterior to anterior include the sinuvertebral nerve, the rami communicantes, and the sympathetic trunk. Diagnosing discogenic low back pain is the key to successful treatment. Classically this should be a low back pain in a „band-like” distribution without radiculopathy that is worse in the morning, worse with Valsalva, and aggravated by standing in flexion. Provocative discography with manometric monitoring is essential in aiding the diagnosis. Once the diagnosis is confirmed, a multitude of invasive therapy may be offered including: L2 root sleeve blocks, intradiscal RFTC, RFTC of the rami communicantes, or Comparative data on the effectiveness of the above-mentioned procedures is lacking and may in fact be an excellent topic for future discussion.

discogenic back pain - discogram - annuloplasty

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