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Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2017; 27(04): 211-217
DOI: 10.1055/s-0043-113046
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Konservative Therapie degenerativer Wirbelsäulenerkrankungen Teil I – Pathogenese, Klinische Symptomatik und Diagnostik

Conservative Treatment of Degenerative Lumbar Spine Diseases Part I – Pathogenesis, Clinical Signs And Diagnosis
Anke Steinmetz
1   Konservative Orthopädie und Muskuloskeletales Zentrum, Loreley-Kliniken, Oberwesel
,
Stefan Delank
2   Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Halle, Martin-Luther-Universität Halle-Wittenberg, Sachsen-Anhalt
› Author Affiliations
Further Information

Publication History

eingereicht 30 March 2017

angenommen 06 June 2017

Publication Date:
04 September 2017 (online)

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Zusammenfassung

Degenerative Wirbelsäulenerkrankungen sind durch natürliche Abnutzungs- und Alterungsprozesse gekennzeichnet. Sie nehmen ihren Ursprung mit Abnahme des Flüssigkeitsgehalts der Bandscheiben ab dem 2. Lebensjahrzehnt, sind jedoch nicht automatisch mit klinischen Symptomen vergesellschaftet. Degenerative Wirbelsäulenerkrankungen können durch Schmerzen symptomatisch werden und zu neurologischen Ausfällen führen. Allerdings können bislang nur für weniger als 15% der Rückenschmerzen spezifische Ursachen beschrieben werden, in der Mehrheit der Fälle liegt ein nicht-spezifischer Kreuz- bzw. Rückenschmerz vor. Für die Chronifizierung des nicht-spezifischen Rückenschmerzes spielen insbesondere psychosoziale Faktoren eine große Rolle.

Ziel der Diagnostik muss die Abgrenzung spezifischer Rückenschmerzentitäten vom nicht-spezifischen Kreuzschmerz sein. Deren Basis besteht in einer ausführlichen Schmerzanamnese inklusive der Erhebung spezifischer Warnsignale (sogenannte red und yellow flags) und einer manualmedizinisch-neuroorthopädischen Untersuchung, welche ggf. durch radiologische Untersuchungen ergänzt wird. Bei Hinweisen auf psychosoziale Einflussfaktoren ist eine Multimodale Diagnostik unter Einbeziehung einer psychologischen Diagnostik anzustreben.

Abstract

Degenerative changes of the spine occur within the physiological aging process. They are initiated by the reduction of the disc fluid content in the second decade, but are not automatically associated with clinical symptoms. Degenerative spine disease can lead to pain and even neurological symptoms. However, in only 15% actually it’s possible to find specific causes for low back pain, the majority of low back pain presents as non-specific low back pain. Psychological risk factors can lead to the development of a chronic pain syndrome. The diagnostic aim in low back pain is to differentiate between specific and non-specific low back pain. The diagnostic procedure is based upon a detailed pain history including specific warn symptoms (red and yellow flags) and a clinical examination, which is completed by imaging techniques, if necessary. In case of existing psychosocial risk factors an interdisciplinary multimodal diagnostic setting including a psychological exploration is required.

Schlüsselwörter

spezifischer Rückenschmerz - nicht-spezifischer Kreuz- und Rückenschmerz - red flags - yellow flags - multimodale Diagnostik

Key words

specific low back pain - non-specific low back pain - red flags - yellow flags - multimodal diagnostic
 

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