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Anästhesiol Intensivmed Notfallmed Schmerzther 2005; 40(3): 179-183
DOI: 10.1055/s-2005-861034
Fallbericht
© Georg Thieme Verlag KG Stuttgart · New York

CT-gesteuerte perkutane Nukleotomie mit dem Dissektor zur Therapie chronischer Rückenschmerzen mit radikulärer Ausstrahlung

CT-Controlled Percutaneous Lumbar Discectomy in Therapy of Radicular PainP.  Lierz1 , P.  Felleiter1 , K.  Alo1
  • 1Marienkrankenhaus Soest, Abt. für Anästhesiologie und Intensivmedizin
Further Information

Publication History

Publication Date:
16 March 2005 (online)

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Zusammenfassung

Mit dem Dekompressor®-System steht eine weitere minimal invasive Technik zur Entfernung von Bandscheibengewebe zur Verfügung. Wir berichten erstmals über den Einsatz dieser Technik unter CT-Kontrolle. Bei einem 49-jährigen Patienten mit einer schmerzhaften Protrusion im Bereich L4/5 wurde unter CT-Kontrolle ein Teil des Bandscheibenkerns entfernt. Der Patient zeigte einen raschen und anhaltenden Rückgang der Schmerzen. Mit diesem neuen System ist erstmalig eine Quantifizierung und histologische Untersuchung des entfernten Gewebes möglich. Durch die Darstellung der Punktion im CT ist eine sehr hohe Zielgenauigkeit des Verfahrens erreichbar.

Abstract

Percutaneous disc decompression using the Decompressor® system is another treatment option for patients suffering from chronic discogenic leg pain. This is the first report on a patient undergoing this procedure under CT-control. A 49 year old man with radicular leg pain showed significant pain reduction after percutaneus decompression of a discal herniation at the L4/5 level. The new system enables qualitative and quantitative measures of the removed disc material. CT-control ensures exact positioning of the device.

Schlüsselwörter

Bandscheibe - Nukleotomie - Nucleous pulposus - Dekompressor - radikuläre Rückenschmerzen

Key words

Intervertebral disc - percutaneous discectomy - decompression - radicular pain - discogenic leg pain

Literatur

  • 1 Bolten W, Kempel-Waibel A, Pforringer W. Analyse der Krankheitskosten bei Rückenschmerzen.  Med Klin. 1998;  93 388-393
    CrossrefPubMedGoogle Scholar
  • 2 Raspe H H, Wasmus A, Greif G, Kohlmann T, Kindel P, Mahrenholtz M. Rückenschmerzen in Hannover.  Aktuel Rheumatol. 1990;  15 32-37
    PubMedGoogle Scholar
  • 3 Prescher A. Anatomy and pathology of the aging spine.  Eur J Radiol. 1998;  27 181-195
    CrossrefPubMedGoogle Scholar
  • 4 Coppes M H, Marani E, Thomeer R T, Groen G J. Innervation of the painful lumbar discs.  Spine. 1997;  22 2342-2350
    Google Scholar
  • 5 Lee C K, Vessa P, Lee J K. Chronic disabling low back pain syndrome caused by internal disc derangements: The results of disc excision and posterior interbody fusion.  Spine. 1995;  20 356-360
    CrossrefPubMedGoogle Scholar
  • 6 Takahashi K, Shima I, Porter R W. Nerve root pressure in lumbar disc herniation.  Spine. 1999;  24 2003-2006
    CrossrefPubMedGoogle Scholar
  • 7 Smith S E, Darden B V, Rhyne A L, Wood K E. Outcome of unoperated discogram-positive low back pain.  Spine. 1995;  20 1997-2000
    PubMedGoogle Scholar
  • 8 Caragee E J, Hahn M, Suen P, Kim D. Clinical outcomes after lumbar discectomy for sciatica: The effects of fragment type and annular competence.  J Bone Joint Surg. 2003;  85-A 102-108
    PubMedGoogle Scholar
  • 9 Mayer H M. Spine update: Percutaneous lumbar disc surgery.  Spine. 1994;  19 2719-2723
    PubMedGoogle Scholar
  • 10 Stolke D, Sollmann W P, Seifert V. Intra- and postoperative complications in lumbar disc surgery.  Spine. 1989;  14 56-59
    CrossrefPubMedGoogle Scholar
  • 11 Ramirez L F, Thisted R. Using a national health care data base to determine surgical complications in community hospitals: Lumbar discectomy as an example.  Neurosurgery. 1989;  25 218-225
    PubMedGoogle Scholar
  • 12 Ramirez L F, Thisted R. Complications and demographic characteristics of patients undergoing lumbar discectomy in community hospitals.  Neurosurgery. 1989;  25 226 - 230
    CrossrefPubMedGoogle Scholar
  • 13 Kambin P, Brager M D. Percutaneous posterolateral discectomy: Anatomy and mechanism.  Clin Orthop. 1987;  223 145-154
    PubMedGoogle Scholar
  • 14 Kambin P, Schaffer J L. Percutaneous lumbar discectomy: Review of 100 patients and current practice.  Clin Orthop. 1989;  238 24-34
    PubMedGoogle Scholar
  • 15 Karasek M, Bogduk N. Two-year follow-up of a controlled trial of intradiscal electrothermal annuloplasty for chronic low back pain resulting from internal disc disruption.  Spine. 2002;  2 343-350
    PubMedGoogle Scholar
  • 16 Nerubay J, Caspi I, Levinkopf M, Tadmor A, Bubis J J. Percutaneous laser nucleolysis of the intervertebral lumbar disc: An experimental study.  Clin Orthop. 1997;  337 42-44
    PubMedGoogle Scholar
  • 17 Sasaki M, Takahashi T, Miyahara K, Hirose T. Effects of chondroitinase ABC on intradiscal pressure in sheep: An in vivo study.  Spine. 2001;  26 463-468
    CrossrefPubMedGoogle Scholar
  • 18 Chen Y C, Sang-heon Lee M D, Chen D. Intradiscal pressure study of percutaneous disc decompression with nucleoplasty in human cadavers.  Spine. 2003;  28 661-665
    CrossrefPubMedGoogle Scholar
  • 19 Hijikata S. Percutaneous nucleotomy. A new concept technique and 12 years’ experience.  Clin Orthop. 1989;  238 9-23
    PubMedGoogle Scholar
  • 20 Saal J S, Saal J A. Management of chronic discogenic low back pain with a thermal intradiscal catheter: A preliminary report.  Spine. 2000;  25 382-388
    Google Scholar
  • 21 Choy D S, Case R B, Fielding W, Hughes J, Liebler W, Asher P. Percutaneous laser nucleolysis of lumbar disks.  N Engl J Med. 1987;  317 771-772
    PubMedGoogle Scholar
  • 22 Eggers P E. Coblation: A newly described method for soft tissue surgery.  Research Outcomes in Arthroscopic Surgery. 1997;  2 1-4
    PubMedGoogle Scholar
  • 23 Brown M D. Update of chemonucleolysis.  Spine. 1996;  21 62S-68S
    PubMedGoogle Scholar
  • 24 Chen Y. Nucleoplasty for chronic discogenic back pain with and without sciatica: 1-year clinical follow-up study.  In: International Spinal Injection Society, 10th Annual Meeting, September 7, 2002, Austin, TX. 
    Google Scholar
  • 25 Sharps L, Isaac Z. Percutaneous disc decompression using nucleoplasty.  Pain Physician. 2002;  5 121-126
    PubMedGoogle Scholar
  • 26 Singh V, Piryani C, Liao K. Percutaneous disc decompression using coblation (nucleoplasty) in the treatment of chronic discogenic pain.  Pain Physician. 2002;  5 250-259
    PubMedGoogle Scholar
  • 27 Postacchini F. Management of herniation of the lumbar disc.  J Bone Joint Surg Br. 1999;  81 567-576
    CrossrefPubMedGoogle Scholar
  • 28 Melrose J, Taylor T K, Ghosh P, Holbert C, Macpherson C, Bellenger C R. Intervertebral disc reconstitution after chemonucleolysis with chymopapain is dependent on dosage.  Spine. 1996;  21 9-17
    CrossrefPubMedGoogle Scholar
  • 29 Maroon J C, Allen R. A retrospective study of 1054 automated percutaneous lumbar discectomy (APLD) cases: a 20-month clinical follow-up at 35 U.S. centers.  J Neurol Orthop Med Surg. 1989;  10 335-337
    PubMedGoogle Scholar
  • 30 Alo K M, Wright R E, Brandt S A, Sutcliffe J. Percutaneous lumbar discectomy: Follow-up of the initial cohort of 50 patients with chronic radicular pain.  Pain Practice. 2004;  4 19-29
    CrossrefPubMedGoogle Scholar

Dr. med. Peter Lierz

Abteilung für Anästhesiologie und Intensivmedizin, Marienkrankenhaus Soest ·

Widumgasse 5 · 59494 Soest

Email: dr.lierz@marienkrankenhaus-soest.de

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