CT-gesteuerte perkutane Nukleotomie mit dem Dissektor zur Therapie chronischer Rückenschmerzen mit radikulärer Ausstrahlung

Zusammenfassung

Mit dem Dekompressor®-System steht eine weitere minimal invasive Technik zur Entfernung von Bandscheibengewebe zur Verfügung. Wir berichten erstmals über den Einsatz dieser Technik unter CT-Kontrolle. Bei einem 49-jährigen Patienten mit einer schmerzhaften Protrusion im Bereich L4/5 wurde unter CT-Kontrolle ein Teil des Bandscheibenkerns entfernt. Der Patient zeigte einen raschen und anhaltenden Rückgang der Schmerzen. Mit diesem neuen System ist erstmalig eine Quantifizierung und histologische Untersuchung des entfernten Gewebes möglich. Durch die Darstellung der Punktion im CT ist eine sehr hohe Zielgenauigkeit des Verfahrens erreichbar.

Abstract

Percutaneous disc decompression using the Decompressor® system is another treatment option for patients suffering from chronic discogenic leg pain. This is the first report on a patient undergoing this procedure under CT-control. A 49 year old man with radicular leg pain showed significant pain reduction after percutaneus decompression of a discal herniation at the L4/5 level. The new system enables qualitative and quantitative measures of the removed disc material. CT-control ensures exact positioning of the device.

Schlüsselwörter

Bandscheibe - Nukleotomie - Nucleous pulposus - Dekompressor - radikuläre Rückenschmerzen

Key words

Intervertebral disc - percutaneous discectomy - decompression - radicular pain - discogenic leg pain

Literatur

• 1 Bolten W, Kempel-Waibel A, Pforringer W. Analyse der Krankheitskosten bei Rückenschmerzen.  Med Klin. 1998;  93 388-393
• 2 Raspe H H, Wasmus A, Greif G, Kohlmann T, Kindel P, Mahrenholtz M. Rückenschmerzen in Hannover.  Aktuel Rheumatol. 1990;  15 32-37
• 3 Prescher A. Anatomy and pathology of the aging spine.  Eur J Radiol. 1998;  27 181-195
• 4 Coppes M H, Marani E, Thomeer R T, Groen G J. Innervation of the painful lumbar discs.  Spine. 1997;  22 2342-2350
• 5 Lee C K, Vessa P, Lee J K. Chronic disabling low back pain syndrome caused by internal disc derangements: The results of disc excision and posterior interbody fusion.  Spine. 1995;  20 356-360
• 6 Takahashi K, Shima I, Porter R W. Nerve root pressure in lumbar disc herniation.  Spine. 1999;  24 2003-2006
• 7 Smith S E, Darden B V, Rhyne A L, Wood K E. Outcome of unoperated discogram-positive low back pain.  Spine. 1995;  20 1997-2000
• 8 Caragee E J, Hahn M, Suen P, Kim D. Clinical outcomes after lumbar discectomy for sciatica: The effects of fragment type and annular competence.  J Bone Joint Surg. 2003;  85-A 102-108
• 9 Mayer H M. Spine update: Percutaneous lumbar disc surgery.  Spine. 1994;  19 2719-2723
• 10 Stolke D, Sollmann W P, Seifert V. Intra- and postoperative complications in lumbar disc surgery.  Spine. 1989;  14 56-59
• 11 Ramirez L F, Thisted R. Using a national health care data base to determine surgical complications in community hospitals: Lumbar discectomy as an example.  Neurosurgery. 1989;  25 218-225
• 12 Ramirez L F, Thisted R. Complications and demographic characteristics of patients undergoing lumbar discectomy in community hospitals.  Neurosurgery. 1989;  25 226 - 230
• 13 Kambin P, Brager M D. Percutaneous posterolateral discectomy: Anatomy and mechanism.  Clin Orthop. 1987;  223 145-154
• 14 Kambin P, Schaffer J L. Percutaneous lumbar discectomy: Review of 100 patients and current practice.  Clin Orthop. 1989;  238 24-34
• 15 Karasek M, Bogduk N. Two-year follow-up of a controlled trial of intradiscal electrothermal annuloplasty for chronic low back pain resulting from internal disc disruption.  Spine. 2002;  2 343-350
• 16 Nerubay J, Caspi I, Levinkopf M, Tadmor A, Bubis J J. Percutaneous laser nucleolysis of the intervertebral lumbar disc: An experimental study.  Clin Orthop. 1997;  337 42-44
• 17 Sasaki M, Takahashi T, Miyahara K, Hirose T. Effects of chondroitinase ABC on intradiscal pressure in sheep: An in vivo study.  Spine. 2001;  26 463-468
• 18 Chen Y C, Sang-heon Lee M D, Chen D. Intradiscal pressure study of percutaneous disc decompression with nucleoplasty in human cadavers.  Spine. 2003;  28 661-665
• 19 Hijikata S. Percutaneous nucleotomy. A new concept technique and 12 years’ experience.  Clin Orthop. 1989;  238 9-23
• 20 Saal J S, Saal J A. Management of chronic discogenic low back pain with a thermal intradiscal catheter: A preliminary report.  Spine. 2000;  25 382-388
• 21 Choy D S, Case R B, Fielding W, Hughes J, Liebler W, Asher P. Percutaneous laser nucleolysis of lumbar disks.  N Engl J Med. 1987;  317 771-772
• 22 Eggers P E. Coblation: A newly described method for soft tissue surgery.  Research Outcomes in Arthroscopic Surgery. 1997;  2 1-4
• 23 Brown M D. Update of chemonucleolysis.  Spine. 1996;  21 62S-68S
• 24 Chen Y. Nucleoplasty for chronic discogenic back pain with and without sciatica: 1-year clinical follow-up study.  In: International Spinal Injection Society, 10th Annual Meeting, September 7, 2002, Austin, TX. 
• 25 Sharps L, Isaac Z. Percutaneous disc decompression using nucleoplasty.  Pain Physician. 2002;  5 121-126
• 26 Singh V, Piryani C, Liao K. Percutaneous disc decompression using coblation (nucleoplasty) in the treatment of chronic discogenic pain.  Pain Physician. 2002;  5 250-259
• 27 Postacchini F. Management of herniation of the lumbar disc.  J Bone Joint Surg Br. 1999;  81 567-576
• 28 Melrose J, Taylor T K, Ghosh P, Holbert C, Macpherson C, Bellenger C R. Intervertebral disc reconstitution after chemonucleolysis with chymopapain is dependent on dosage.  Spine. 1996;  21 9-17
• 29 Maroon J C, Allen R. A retrospective study of 1054 automated percutaneous lumbar discectomy (APLD) cases: a 20-month clinical follow-up at 35 U.S. centers.  J Neurol Orthop Med Surg. 1989;  10 335-337
• 30 Alo K M, Wright R E, Brandt S A, Sutcliffe J. Percutaneous lumbar discectomy: Follow-up of the initial cohort of 50 patients with chronic radicular pain.  Pain Practice. 2004;  4 19-29