Die Wirbelsäule 2019; 03(02): 107-111
DOI: 10.1055/a-0810-3334
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Der lumbale Bandscheibenvorfall – Spontanverlauf, Therapieoptionen und klinische Ergebnisse

Lumbar disc herniation – natural course, treatment and clinical outcome
Kirsten Schmieder
Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum
› Author Affiliations
Further Information

Publication History

Publication Date:
17 April 2019 (online)

Zusammenfassung

In der Therapie des lumbalen Bandscheibenvorfalls zeigt die auf den jeweiligen Patienten abgestimmte Kombination aus konservativen und unter Umständen operativen Therapiemaßnahmen die besten Ergebnisse. Es herrscht Übereinstimmung darüber, dass bei bestehenden höhergradigen neurologischen Ausfällen, insbesondere beim Kaudasyndrom, eine operative Therapie erfolgen soll. Beim Vorliegen eines reinen Schmerzsyndromes ist die Datenlage zur Auswahl und Abfolge der verschiedenen Therapieoptionen hingegen nicht eindeutig. Hinsichtlich der Anwendung einer bestimmten operativen Technik gibt es keine eindeutige Überlegenheit eines speziellen Verfahrens. Bei intraoperativ festgestellten großen Defekten im Annulus fibrosus bei jüngeren Frauen kann die Implantation eines Annulusverschlusssystems sinnvoll sein. Die Operationsergebnisse nach Operation eines lumbalen Bandscheibenvorfalls sind gut. In der Rezidivsituation kommt es ebenfalls zu einem guten postoperativen Ergebnis, allerdings wird das Niveau des Ersteingriffs nicht erreicht. Der postoperative Verlauf wird zusätzlich richtungsweisend von Kriterien wie dem präoperativen Aktivitätsausmaß, der Dauer der präoperativen Arbeitsunfähigkeit und psychischen Veränderungen bestimmt. Diese müssen im individuellen Patientenmanagement entsprechend Berücksichtigung finden.

Abstract

Treatment results in patients with lumbar disc herniation are best if a combination of conservative and surgical treatment is combined based on symptoms, images and functional status of the individual patient. There is general acceptance that patients with severe neurological deficits or a cauda syndrome are candidates for surgery. In the presence of back and/or leg pain recommendations are still a matter of debate. The results of surgical versus conservative treatment are similar after two years. However, the long-term results favor surgery. The results achieved after surgery are good and there is no significant advantage of one surgical technic compared to the others. In the presence of a large defect in the annulus in a younger female population an annulus repair system can be used to reduce the possibility of a re-herniation. Surgical results after recurrent disc herniation are still favourable but not as good as after first surgery. The results and the postoperative course are also influenced by various additional factors such as preoperative level of fitness, preoperative length of sick leave and anxiety and mental health. These additional factors have to be recognised and adequately addressed to obtain optimal results after surgery.

 
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