Lumbale Spinalkanalstenose

The number of patients with the diagnosis of lumbar spinal stenosis (LSS) is steadily increasing and simultaneously, the patients' expectations are also increasing. Nevertheless, evidence from studies for the appropriate treatment is still lacking. Treatment options mainly result from the practitioner 's experience and the clinical focus. The findings described in magnetic resonance imaging (MRI) often do not correlate with the patient's symptoms. Basically, the treatment should be started with aconservative treatment and preferably with a multimodal approach. Severe pain with extensive neurogenic claudication symptoms and unsuccessful conservative treatment should be treated surgically. Absolute indications for surgery, such as aconus-cauda syndrome are rare. The goal of all surgical procedures is to decompress the spinal canal without compromising the stability of the motion segment. Instability can also make an additional fusion necessary

Lumbale Spinalkanalstenose

The number of patients with a diagnosis of lumbar spinal stenosis (LSS) is steadily increasing and the expectations of patients are high; however, valid data for an appropriate therapy are lacking. Treatment is mostly the result of the surgeon's experience and the clinical focus. The findings in magnetic resonance imaging (MRI) often do not correlate with the patient's symptoms. It is proposed that treatment should start with a conservative multimodal approach. Increased pain with neurogenic claudication symptoms under conservative treatment should be treated surgically. Absolute indications for surgery, such as a conus cauda syndrome are rare. The goal of all surgical procedures is to decompress the spinal canal without compromising the stability of the motion segment. This can also make an additional fusion necessary

Therapieresistente Kokzygodynie sollte nicht länger als Mythos angesehen werden

BackgroundCoccygodynia is still often considered amystery, and many patients are not taken seriously with their problems and pain.CaseA51-year-old thin lady presented at our clinic with lifelong, persistent low back pain. The clinical examination indicated suspicion of coccygodynia. A functional X-ray revealed ahypermobile os coccygeum with dorsal tilt. After a total coccygectomy via ay-shaped approach, she was completely pain free at the 12months follow-up examination. No surgical site infection occurred in this period

Perioperative Schmerztherapie in der Orthopädie

A sufficient pain management forms the foundation for a successful operative treatment of orthopedic patients. Clinical guideline standards must be provided to ensure safe and immediate pain therapy. Training in these guidelines should be held for clinical personnel on a regular basis. The visual analog scale (VAS) and the numerical rating scale (NRS) are valid instruments used for assessment of pain intensity. A sufficient pain management includes basic analgesics, analgesics on demand as well as special features, such as regional nerve blocks and patient-controlled anesthesia (PCA). The basic analgesics are primarily the groups of classical non-steroidal anti-inflammatory drugs (NSAID) and cyclooxygenase 2 (COX-2) inhibitors as well as stand by analgesics, such as metamizole. If there is further need for pain therapy, medium strong and strong opioids can be used but adverse events must be taken into consideration

Einflüsse der Bandscheibendegeneration bei der Entwicklung eines lumbalen Bandscheibenvorfalls

Purpose: The present clinical-radiological study examines retrospectively the relation between lumbar disc prolapse and degenerations like chondrosis and spondylosis. Method: Firstly the relation between disc prolapse and chondrosis was examined. 44 patients with disc prolapse and chondrosis in actual MRI scans in the same segment were recruited in our clinic. By regarding older MRI scans, we could find out which finding was first to occur. Concerning the second question, we followed patients with spondylosis to see if they could progress to a disc prolapse. Results: In 67% of our cases with disc prolapse and chondrosis, a chondrosis was seen before the disc prolapse. More than a half had had a spondylosis and a chondrosis in the same segment before the herniation. Only 33% of our cases showed a prolapse before chondrosis. Conclusion: Concerning patients with disc prolapse and chondrosis in the same segment, chondrosis was seen before the herniation in most cases. Also patients with spondylosis progress to a herniation. A causal relation between both radiological findings is not possible. In a future study it must be analysed with statistical tests whether these results are generally valid

Gibt es segmentabhängige Unterschiede bei lumbalen Spondylodesen? – Vergleich der Segmente L IV/V und L V/S I bei der transforaminalen lumbalen interkorporellen Fusion (TLIF)

Background: The aim of this study was to report surgical results with open TLIF (transforaminal lumbar intervertebral fusion) of segment L V/S I, in comparison with TLIF of segment L IV/V. Patients and Methods: 60 patients with degenerative spine disease were operated with TLIF spondylodesis and followed up in a clinical and radiological study. 30 patients were operated in segment L IV/V (group 1) and another 30 in segment L V/S I (group 2). These patients were followed up 2 weeks and 12 months after surgery, by means of a clinical examination and questionnaires on pain (visual analogue scale) and quality of life (Oswestry score). Results: The rate of intra-and postoperative complications was 5% in all 60 patients; the fusion ratewas 100%. In all patients, a 70% improvement in back pain, leg pain and quality of life was achieved after 12 months. For leg pain and quality of life, a significantly better result was seen in group 1 than in group 2 two weeks after the operation. This may be explained by reversible dysaesthesias in 3 patients in group 2. In 2 patients in group 2, it was necessary to convert from TLIF to ALIF (anterior lumbar interbody fusion). Directly after the operation, the mean intervertebral height was 8.2mm in group 1 and 7.3 mm in group 2, in comparison with 7.7 mm and 6.8 mm after one year, respectively. Conclusion: In patients with contraction osteochondrosis in segment L V/S I, spondylodesis in segment L V/S I is - for anatomical reasons - more likely to be linked to reversible nerve irritations than with segment L IV/V. In some cases, conversion from TLIF on ALIF is necessary. In patients with degenerative spine disease, TLIF in segments L IV/V and L V/S I is absolutely accepted as a safe and up-to-date procedure

Injektionstherapie bei Zervikal- und Lumbalsyndromen

In cervical and lumbar pain syndromes special injections are key for effective pain therapy. Depending on the origin of pain injections are placed at the nerve root or the joints. Thus, the vicious cycle can be stopped. A correct technical procedure is of enormous importance. Because pharmacological effects and special complications are possible, monitoring and precautions are mandatory