Schmerzzentralisierung und MRT-Befunde der lumbalen Bandscheiben bei Patienten mit chronischen lumbalen Rückenschmerzen

Zusammenfassung

Im Rahmen der Bewertung von lumbalen Rückenschmerzen ist Schmerzzentralisierung ein spezifischer Befund. Ein dynamisches internes „Bandscheibenmodell” mit hoher positiver Korrelation mit Schmerzen während der Provokationsdiskografie wurde als ein der Schmerzzentralisierung zugrunde liegender Mechanismus hypothetisiert. Zwar ergibt die MRT häufig auch bei asymptomatischen Personen strukturelle Abnormalitäten, aber der Zusammenhang zwischen der Zentralisierung bei symptomatischen Personen und der abgebildeten Bandscheibenpathologie wurde bisher nicht evaluiert. Das Ziel dieser Studie bestand darin, den Zusammenhang (kriterienbezogene Validität) zwischen dem Zentralisierungsphänomen und den MRT-Befunden zur Pathologie der Lendenbandscheiben als Kriteriumsstandard bei Patienten mit chronischen lumbalen Rückenschmerzen zu bewerten.

Zwischen Schmerzzentralisierung und Abnormalitäten der LWS-Bandscheiben besteht ein Zusammenhang. Da das Zentralisierungsphänomen stark mit guten Behandlungsergebnissen assoziiert wird, empfiehlt sich vor der Überweisung an einen Chirurgen eine an der Zentralisierung orientierte konservative Behandlung der Bandscheibenpathologie.

Abstract

In the assessment of low back pain (LBP) pain centralization is a specific finding. A dynamic ”internal disc model” has been hypothesized as underlying mechanism for pain centralization, which has shown a high positive correlation with pain during provocation discography. Though structural abnormalities on MRI are common among asymptomatic individuals, the association between centralization among symptomatic individuals with imaged disc pathology has not yet been evaluated. The aim of this study was to estimate the association (criterion-related validity) between the centralization phenomenon and magnetic resonance imaging (MRI) findings of lumbar disc pathology as the criterion standard among chronic low back pain patients.

Pain centralization is associated with abnormalities of lumbar discs. As the centralization phenomenon closely correlates with good treatment outcomes before surgical referral centralization-guided conservative treatment is recommended for disc pathologies.

lumbale Rückenschmerzen - Zentralisierungsphänomen - MRT - McKenzie-Methode - diskogene Schmerzen - Bandscheibenschmerzen

low back pain - centralization phenomenon - MRI - McKenzie method - discogenic pain

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