Zusammenfassung
Die Wirbelsäule gehört zu den häufigsten Quellen von Schmerzzuständen. Neben der Anamnese und einer gründlichen klinischen Untersuchung hat die radiologische Diagnostik - insbesondere mit den modernen Schnittbildverfahren wie CT und MRT - einen wichtigen Stellenwert. Nach Ausschluss einer malignen Schmerzursache ist zunächst ein konservativer Therapieversuch gerechtfertigt. Bei ausbleibender Besserung kann eine minimalinvasive, bildgestützte, diagnostische oder therapeutische Infiltration erwogen werden. Dabei soll der interventionell tätige Radiologe dem Team angehören, welches die klinische Strategie bestimmt. Dieser Artikel beschreibt Epidemiologie und Pathophysiologie, Bildführungstechniken, das technische Vorgehen, allgemeine präinterventionelle Abklärungen, verwendete Medikamente, Indikationen, mögliche Komplikationen sowie die Wertung der einzelnen diagnostischen und therapeutischen minimalinvasiven bildgestützten Verfahren bei Lumbalgien. In diesem Zusammenhang werden die interventionell radiologischen Therapiemöglichkeiten in Form der Facettenblockaden, periradikulären und periduralen Infiltration sowie ISG-Blockaden erörtert.
Abstract
Spinal affections belong to the most widespread sources of back pain. Beside medical history and clinical examination, the radiological investigation plays an important rote in the clinical workup especially with the modern Cross sectional imaging methods such as computed and magnetic resonance tomography. After exclusion of a malignant disease usually a conservative therapeutic approach is the first line treatment option. If the conservative treatment approach falls a minimalinvasive image guided diagnostic or therapeutic infiltration may be considered. Thereby the interventional radiologist should be a member of the team which decides the clinical strategy. This article describes epidemiology and pathophysiology, common pre-interventional diagnostic strategies, drugs, indications, possible complications and the impact of diagnostic and therapeutic minimally invasive image guided techniques in low back pain. In this context facet joint blockade, periradicular and peridural therapy as well as sacroiliac joint blockades are discussed.
Key words
Lumbar pain therapy · minimal invasive therapy · image guided therapy facet blockade · root blockade · periradicular therapy sacroiliac joint blockade
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Dr. med. Rolf Hügli
Interventionelle Radiologie
Universitätsspital Basel
Petersgraben 4
CH-4031 Basel
Phone: 0041 61 265-4333
Fax: 0041 61 265-5383
Email: rhuegli@uhbs.ch
