Spezifischer Rückenschmerz – sinnvolle Diagnostik und Therapie aus Sicht der Radiologie

Zusammenfassung

Hintergrund

Diagnostik und Therapie des spezifischen Rückenschmerzes sind ein wichtiges Aufgabenfeld der Radiologie. Aufgrund der hohen Anzahl an erkrankten Patienten ist es wichtig zielgerichtet im Patienteninteresse sowohl diagnostisch als auch therapeutisch zu arbeiten.

Methode

Auf der Basis einer aktuellen Literaturrecherche unter Beachtung der entsprechenden Leitlinien und Expertenmeinungen werden die für den Radiologen wichtigen Aspekte des spezifischen Rückenschmerzes hinsichtlich, Pathogenese, Diagnostik und Therapie dargestellt.

Ergebnisse

Die klinische Untersuchung liefert in Zusammenschau mit der Anamnese eine valide Verdachtsdiagnose, die radiologisch verifiziert werden sollte. Die MRT ist die zielführendste Schnittbilddiagnostik zur Abklärung von spezifischem Rückenschmerz. Ein konventionelles Röntgen in zwei Ebenen im Stehen kann bei Verdacht auf haltungsbedingte Ursachen sinnvoll ergänzt werden. Wenn die klinische Symptomatik zum bildmorphologischen Befund passt, kann eine radiologische Therapie sowohl bei Nervenwurzelaffektion als auch bei entzündlichen Veränderungen der Facettengelenke erfolgen. Die zu erzielende Beschwerdebesserung ist insgesamt als gut zu bewerten, zumindest eine kurzfristige Beschwerdebesserung lässt sich in aller Regel erreichen, bzgl. des Langzeit-Outcomes liegen keine verlässlichen Daten vor. Bei Anwendung triamcinolon-haltiger Präparate sollten niedrige Dosierungen – entsprechend den Empfehlungen der Leitlinien – gewählt werden. Eine Einbettung in ein multimodales schmerztherapeutisches Behandlungskonzept ist zu erwägen.

Schlussfolgerung

Die Radiologie liefert beim spezifischen Rückenschmerz eine richtungsweisende Diagnostik und kann durch die interventionelle Schmerztherapie oftmals zu einer schnellen Beschwerdebesserung führen.

Kernaussagen

• Erst klinisch untersuchen, dann Verdachtsdiagnose radiologisch bestätigen.

• MRT ist in der Regel Methode der Wahl.

• Die interventionelle Schmerztherapie sollte nach maximal 2 Interventionen einen Erfolg zeigen.

• Die Dosis der applizieren Entzündungshemmer ist so niedrig wie eben möglich zu halten.

• Der individuelle Verlauf bestimmt die Anzahl der Interventionen.

Zitierweise

• Stueckle CA, Haage P. Specific back pain – effective diagnosis and treatment from the radiologist’s point of view. Fortschr Röntgenstr 2024; DOI 10.1055/a-2371-1752

Publication History

Received: 14 December 2023

Accepted after revision: 03 June 2024

Article published online:
21 August 2024

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