Schmerzzentralisierung und MRT-Befunde der lumbalen Bandscheiben bei Patienten mit chronischen lumbalen Rückenschmerzen

Zusammenfassung

Im Rahmen der Bewertung von lumbalen Rückenschmerzen ist Schmerzzentralisierung ein spezifischer Befund. Ein dynamisches internes „Bandscheibenmodell” mit hoher positiver Korrelation mit Schmerzen während der Provokationsdiskografie wurde als ein der Schmerzzentralisierung zugrunde liegender Mechanismus hypothetisiert. Zwar ergibt die MRT häufig auch bei asymptomatischen Personen strukturelle Abnormalitäten, aber der Zusammenhang zwischen der Zentralisierung bei symptomatischen Personen und der abgebildeten Bandscheibenpathologie wurde bisher nicht evaluiert. Das Ziel dieser Studie bestand darin, den Zusammenhang (kriterienbezogene Validität) zwischen dem Zentralisierungsphänomen und den MRT-Befunden zur Pathologie der Lendenbandscheiben als Kriteriumsstandard bei Patienten mit chronischen lumbalen Rückenschmerzen zu bewerten.

Zwischen Schmerzzentralisierung und Abnormalitäten der LWS-Bandscheiben besteht ein Zusammenhang. Da das Zentralisierungsphänomen stark mit guten Behandlungsergebnissen assoziiert wird, empfiehlt sich vor der Überweisung an einen Chirurgen eine an der Zentralisierung orientierte konservative Behandlung der Bandscheibenpathologie.

Abstract

In the assessment of low back pain (LBP) pain centralization is a specific finding. A dynamic ”internal disc model” has been hypothesized as underlying mechanism for pain centralization, which has shown a high positive correlation with pain during provocation discography. Though structural abnormalities on MRI are common among asymptomatic individuals, the association between centralization among symptomatic individuals with imaged disc pathology has not yet been evaluated. The aim of this study was to estimate the association (criterion-related validity) between the centralization phenomenon and magnetic resonance imaging (MRI) findings of lumbar disc pathology as the criterion standard among chronic low back pain patients.

Pain centralization is associated with abnormalities of lumbar discs. As the centralization phenomenon closely correlates with good treatment outcomes before surgical referral centralization-guided conservative treatment is recommended for disc pathologies.

Schlüsselwörter

lumbale Rückenschmerzen - Zentralisierungsphänomen - MRT - McKenzie-Methode - diskogene Schmerzen - Bandscheibenschmerzen

Key words

low back pain - centralization phenomenon - MRI - McKenzie method - discogenic pain

Literatur

• 1 Aina A, May S, Clare H. The centralization phenomenon of spinal symptoms – a systematic review.  Man Ther. 2004;  9 134-143
• 2 Aprill C, Bogduk N. High-intensity zone: a diagnostic sign of painful disc on magnetic resonance imaging.  Br J Radiol. 1992;  65 361-369
• 3 Beattie P F, Brooks W M, Rothstein J M et al. Effect of lordosis on the position of the nucleus pulposus in supine subjects. A study using magnetic resonance imaging.  Spine. 1994;  19 2096-2102
• 4 Boden S D, Davis D O, Dina T S et al. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation.  J Bone Joint Surg Am. 1990;  72 403-408
• 5 Bogduk N. Truth in musculoskeletal medicine. II: Truth in diagnosis. II: Validity.  Australian Musculoskel Med. 1999;  2 1-11
• 6 Boos N, Rieder R, Schade V et al. Volvo award in clinical sciences. The diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations.  Spine. 1995;  20 2613-2625
• 7 Bryant T. Confidence intervals analysis. Computer software; 2.1.2 Build 50. Southampton: University of Southampton; 2004
• 8 Clare H A, Adams R, Maher C G. Reliability of McKenzie classification of patients with cervical and lumbar pain.  J Manipulative Physiol Ther. 2005;  28 122-127
• 9 Donelson R, Grant W, Kamps C et al. Pain response to sagital end-range spinal motion. A prospective, randomized, multicentered trial.  Spine. 1991;  16 S206-S212
• 10 Donelson R, Aprill R, Medcalf R et al. A prospective study of centralization of lumbar and referred pain.  Spine. 1997;  22 1115-1122
• 11 Hamanishi C, Kawabata T, Yosii T et al. Schmorl’s nodes on magnetic resonance imaging. Their incidence and clinical relevance.  Spine. 2004;  19 450-453
• 12 Hassett G, Hart D J, Manek N J et al. Risk factors for progression of lumbar spine disc degeneration: The Chingford Study.  Arthr Rheum. 2003;  48 3112-3127
• 13 Jarvik J J, Hollingworth W, Heagerty P et al. The longitudinal assessment of imaging and disability of the back (LAIDBack) study: Baseline data.  Spine. 2001;  26 1158-1166
• 14 Jensen M C, Brant-Zawadzki M N, Obuchowski N et al. Magnetic resonance imaging of the lumbar spine in people without back pain.  N Engl J Med. 1994;  331 69-73
• 15 Jensen T S, Karppinen J, Sorensen J S et al. Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain.  Eur Spine J. 2008;  17 1407-1422
• 16 Kankaanpää M, Taimela S, Airaksinen O et al. The efficacy of active rehabilitation in chronic low back pain.  Spine. 1999;  24 1034-1042
• 17 Kilpikoski S, Airaksinen O, Kankaanpää M et al. Interexaminer reliability of low back pain assessment using the McKenzie method.  Spine. 2002;  8 E207-E214
• 18 Kilpikoski S. The McKenzie method in assessing, classifying and treating non-specific low back pain in adults with special reference to the centralization phenomenon. Studies in sport, physical education and health; 0356 – 1070;158. Jyväskylä: University of Jyväskylä; 2010
• 19 Kolber M J, Hanney W J. The dynamic disc model: a systematic review of the literature.  Phys Ther Rev. 2009;  14 181-189
• 20 Laslett M, Öberg B, Aprill C N et al. Centralization as a predictor of provocation discography results in chronic low back pain, and the influence of disability and distress on diagnostic power.  Spine J. 2005;  5 370-380
• 21 Long A, Donelson R, Fung T. Does it matter which exercise? A randomized controlled trial of exercise for low back pain.  Spine. 2004;  29 2593-2602
• 22 McKenzie R A, May S (eds).. The lumbar spine mechanical diagnosis and therapy. Waikanae: Spinal Publication; 2003
• 23 Milette P C, Fontaine S, Lepanto L et al. Differentiating lumbar disc protrusions, disc bulges and discs with normal contour but abnormal signal intensity. Magnetic resonance imaging with discographic correlations.  Spine. 1999;  1 44-53
• 24 Moneta G B, Videman T, Kaivanto K et al. Reported pain during lumbar discography as a function of anular ruprures and disc degeneration. A re-analysis of 833 discograms.  Spine. 1994;  19 1968-1974
• 25 Ratzmjou H, Kramer J F, Yamada R. Inter-tester reliability of the McKenzie evaluation in mechanical low back pain.  JOSPT. 2000;  30 368-383
• 26 Riddle D L, Rothstein J M. Intertester reliability of McKenzie’s classifications of the syndrome types present in patients with low-back pain.  Spine. 1993;  18 1333-1344
• 27 Schellhas K P, Pollei S R, Gundry C R et al. Lumbar disc high-intensity zone. Correlation of magnetic resonance imaging and discography.  Spine. 1996;  21 79-86
• 28 Schwarzer A C, Aprill C N, Derby R et al. The prevalence and clinical features of internal disc disruption in patients with chronic low back pain.  Spine. 1995;  20 1878-1883
• 29 Skytte L, May S, Petersen P. Centralization: It’s prognostic value in patients with referred symptoms and sciatica.  Spine. 2005;  30 E293-E299
• 30 Videman T, Battie M C, Gibbons L E et al. Associations between back pain history and lumbar MRI findings.  Spine. 2003;  28 582-588
• 31 Videman T, Nurminen M. The occurrence of annular tear and their relation to lifetime back pain history: A cadaveric study using barium sulphate discography.  Spine. 2004;  29 2668-2676
• 32 Weishaupt D, Zanetti M, Hodler J et al. MR imaging of the lumbar spine: Prevalence of intervertebral disc extrusion and sequesteration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers.  Radiology. 1998;  209 661-666
• 33 Werneke M, Hart D, Cutrone G. Association between directional preference and centralization phenomenon in patients with low back pain.  JOSPT. 2011;  41 22-31