Zusammenfassung
Hintergrund
Die lumbale Facettengelenkdegeneration ist ein multifaktorieller Prozess, welcher eng mit der altersbedingten Degeneration der Bandscheibe verbunden ist und bei älteren Patienten mit einer Häufigkeit zwischen 15 und bis zu 40 % auftreten kann. Darüber hinaus zeigen jüngere Studien einen Zusammenhang zwischen dem verstärkten Auftreten von Entzündungsmediatoren und afferenter Schmerzweiterleitung am Facettengelenk.
Operative Techniken
Die Erstbeschreibung einer minimal-invasiven Technik zur symptomatischen Therapie der degenerativen Facettengelenkerkrankung geht auf das Jahr 1975 zurück. In der Folgezeit wurden weitere Techniken entwickelt, mit unterschiedlichem Wirkungserfolg. Die anatomischen Zielstrukturen der unterschiedlichen Techniken sind entweder der mediale Ast des Ramus dorsalis oder die Facettengelenkkapsel. Die wichtigsten Techniken sind heutzutage die Thermorhizotomie (Thermodenervierung), die Kryorhizotomie (Kryotherapie) und das endoskopische oder perkutane Facettengelenk-Debridement.
Abstract
Background
The degeneration of the lumbar facet joint is a multi-factorial process that is closely linked to degeneration of the intervertebral discs and has been implicated as one of the causes of low-back pain of elderly patients in about 15 up to 40% of cases. Moreover, emerging data suggest that increased inflammatory features play an important role in the progression of lumbar facet joint disease and may serve as a link to the afferent pain nerve fibers.
Operative techniques
Since the first description in 1975 of minimally invasive treatment of lumbar facet joint disease, different techniques have been developed and used with varying results. Today, the major techniques are thermorhizotomy, cryorhizotomy, and endoscopic or percutaneous facet debridement with different anatomical targets, such as the medial branch of the dorsal ramus or facet joint capsule.
Abbreviations
- BW:
-
Bildwandler
- CD :
-
„Cluster of differentiation“
- CGRP :
-
„Calcitonin gene related peptide“
- CT :
-
Computertomographie
- IL :
-
Interleukin
- LWK :
-
Lendenwirbelkörper
- LWS :
-
Lendenwirbelsäule
- MRT :
-
Magnetresonanztomografie
- NGF :
-
„Nerve growth factor“
- NPY :
-
Neuropeptid Y
- PGP9.5:
-
„Protein gene product 9.5“
- RFA :
-
Radiofrequenzablation
- SP :
-
Substanz P
- TH :
-
Tyroxinhydroxylase
- TNF :
-
Tumornekrosefaktor
- VEGF :
-
„Vascular endothelial growth factor“
- VIP :
-
Vasoaktives intestinales Peptid
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F. Faber weist auf folgende Beziehung hin: Beratervertrag von der Firma Medovex.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
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Abbildungen mit freundlicher Unterstützung durch Klaus Bahringer (Medienabteilung der Orthopädischen Klinik, Universität Regensburg, Bad Abbach)
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Faber, F. Das degenerativ veränderte lumbale Facettengelenk. Orthopäde 48, 77–83 (2019). https://doi.org/10.1007/s00132-018-03667-5
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DOI: https://doi.org/10.1007/s00132-018-03667-5