Kortison-Injektionen an der Wirbelsäule (periartikulär, nervennah, epidural)

Zusammenfassung

Wirbelsäulennahe Kortison-Injektionen gehören zu den heutzutage am weitesten verbreiteten medizinischen Prozeduren überhaupt. Durch die epidurale, intra- und periartikuläre Applikation der Steroide sollen inflammatorisch getriggerte, therapieresistente Schmerzen von nozizeptivem und neuropathischem Charakter beeinflusst werden.

Auch wenn das Risiko der Infiltrationen insgesamt gering ist, wurden Fälle mit schweren neurologischen Komplikationen wie z. B. nach zervikalen, epiduralen transforaminalen Injektionen beschrieben. Insgesamt scheint das Risikoprofil nicht kristalliner Steroide wie dem Dexamethason bei allenfalls geringgradig niedrigerer Effektivität im Vergleich mit den häufig gebrauchten kristallinen Steroiden günstiger zu sein.

Die wissenschaftliche Evidenz zur Effektivität der verschiedenen wirbelsäulennahen Steroidinfiltrationen steht in einem starken Kontrast zu deren häufigen Anwendungen. Sämtliche Techniken der Steroid-Applikation haben einen limitierten Nutzen bei lokalen Schmerzen, die beste Evidenz für eine kurzfristige Schmerzlinderung besteht für die epidurale Steroidinfiltration bei radikulären Schmerzen.

Abstract

Spinal corticosteroid injections are nowadays one of the most commonly performed procedures in medicine. Epidural, intra- and periarticular applications of steroids aim at nociceptive and neuropathic pain that is triggered by inflammatory stimuli.

Even though the overall risk of spinal infiltrations is low, cases with severe neurological complications have been reported in the literature, e. g. after cervical transforaminal injections. Furthermore, there are concerns over the safety profile of particulate steroids which has to be weighed against a, at best, slightly higher efficacy.

The scientific evidence of the spinal steroid infiltrations stands against its common use. Efficacy is limited in back pain and the best evidence (Level II) exists for short-term control of radiculopathy by epidural injections.

Schlüsselwörter

Spinale Injektion - Steroid-Injektion - Schmerztherapie

Keywords

spinal injection technique - steroid injection - pain management

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