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Sportverletz Sportschaden 2020; 34(01): 33-41
DOI: 10.1055/a-0751-0583
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Wirbelsäulennahe Injektionstherapie im Sport

Spine injections in athletes
Andreas Veihelmann
1   SRH-Gesundheitszentrum Bad Herrenalb
2   Sportklinik Stuttgart GmbH
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Publication History

Publication Date:
27 February 2019 (online)

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Zusammenfassung

Wirbelsäulennahe Injektionen werden bei unterschiedlichen spezifischen Ursachen für akuten oder auch chronischen Rücken- und/oder Beinschmerz beim Sportler durchgeführt. Auch wenn diese Injektionen in zahlreichen Leitlinien als Teil der konservativen Therapie implementiert sind, werden diese nach wie vor kontrovers diskutiert. Gerade im Sport rückt die konservative Therapie inklusive wirbelsäulennahe Injektionen in den Focus von Wissenschaft und Forschung. In diesem Artikel werden die unterschiedlichen Formen der bildgesteuerten Injektionstechniken an der Wirbelsäule als schmerztherapeutische Maßnahmen beschrieben und in ihrer Wirksamkeit beleuchtet. Lokale Injektionen der Facettengelenke beim Facettensyndrom und der Bandscheiben beim diskogenen Schmerz scheinen einen eher kurzfristigen Effekt zu haben, während epidurale Injektionen bei Diskusprolaps und/oder epiduraler Fibrose nach Wirbelsäulenoperationen (Postnukleotomie-Syndrom) eine sinnvolle Unterstützung bei der konservativen Therapie sein können. Beim Facettensyndrom scheint die Denervation mittels Radiofrequenz eine effektive Behandlungsmethode für eine kurz- bis mittelfristige Besserung darzustellen. Daneben haben auch Pars-Injektionen beim Pars-interarticularis-Ödem sowie Injektionen beim Sakroiliakalgelenks-Syndrom ihren Stellenwert. Die Medikamente und das Steroidpräparat für wirbelsäulennahe Injektionen müssen sorgfältig ausgewählt werden und werden in Deutschland teilweise als off-label-use eingesetzt, worüber der Patient aufgeklärt werden muss und nicht zu Lasten der gesetzlichen Krankenkassen abgerechnet werden darf.

Abstract

A major proportion of athletes have intermittent acute low back pain at some stage of their sport life. Some athletes develop chronic low back pain, which may be a major source of failing in sports. Facet, epidural and intradiscal steroid injections for specific pain generators in the spine show different short- and long-term results. They can improve low back pain for specific pain generators experienced by back pain patients and might be able to help some of these athletes to avoid open surgery and shorten the time until return to sports (RTS). Facet and intradiscal steroid injections provide only short-term effects in axial low back pain and should therefore be considered with caution, whereas the different forms of epidural steroid injections for sciatica caused by radicular compression seem to be a well-proven adjuvant treatment option within a conservative therapeutic regimen. An overview of the literature related to the use of different steroids has shown that non-particulate steroids provide better results regarding safety and avoidance of major complications, especially when used at the cervical spine. However, in Germany the use of these steroids is still off-label and patients have to provide their informed consent prior to injection. In summary, careful use of spinal injections within a conservative physiotherapeutic regimen seems to improve chronic back pain and, in turn, reduce the time of RTS.

Schlüsselwörter

Wirbelsäulennahe Injektionen - Sportler - spezifischer Rückenschmerz

Key word

spinal/epidural steroid injection - specific low back pain - athlete
 

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