Z Orthop Ihre Grenzgeb 2006; 144(1): 19-26
DOI: 10.1055/s-2006-921463
Wirbelsäule

© Georg Thieme Verlag Stuttgart · New York

Schmerztopik bei lumbalen Bandscheibenschäden

Pain Patterns of Disc Lesions of the Lumbar SpineP. Machacek1 , M. Friedrich1
  • 1Abteilung für Orthopädische Schmerztherapie, Orthopädisches Spital Wien Speising, Wien, Österreich
Further Information

Publication History

Publication Date:
23 February 2006 (online)

Zusammenfassung

Studienziel: Ziel dieser Studie ist es zu klären, wie zuverlässig die in der Literatur angegebenen klassischen Dermatommodelle (Darstellung der Schmerzausstrahlung bei Läsion einzelner Nervenwurzeln) den entsprechenden Segmenten der Lendenwirbelsäule zugeordnet werden können. Methode: Verschiedene Studien, die sich mit bandscheibenbedingten Schmerzprojektionen beschäftigen wurden mittels EDV gesteuerter Literatursuche gefunden und verglichen. Ergebnisse: Bezüglich der Dermatomverläufe im Bereich der unteren LWS gibt es keine eindeutigen Übereinstimmungen. Es besteht ein Widerspruch zwischen der am häufigsten auftretenden Schmerzprojektion (S1) und dem am häufigsten operierten Segment (L4/L5). Schlussfolgerung: Trotz wissenschaftlich fundierter Modelle (Nitta H, Wolff A) ist die Schmerzausstrahlung gegenüber den klassischen Dermatommodellen ein nur bedingt geeigneter Parameter zur Segmentdefinition.

Abstract

Aim: The aim of this study was to find out the reliability of several dermatomic maps (description of pain pattern within a nerve root lesion) according to the respecrive segmental area. Methods: Different studies which deal with pain pattern caused by disc lesions were searched for with MedLine support and then reviewed. Results: A clear correlation between the pain projections of the lumbar spine does not seem to exist. A contradiction of the most common pain projection (S1) and operated disc (L4/5) is described. Conclusion: Even though there are studies of high scientific design and value (Nitta H, Wolff A) the pain pattern of dermatomic maps is only of limited value for the definition of the affected segment.

Literatur

  • 1 Benini A. Der lumbale Bandscheibenschaden. Kohlhammer, Stuttgart, Berlin, Köln 1991; 126
  • 2 Bernini P M, Simeone F A. Reflex sympathetic dystrophy associated with low lumbar disc herniation.  Spine. 1981;  6 180
  • 3 Krämer J. Bandscheibenbedingte Erkrankungen. Thieme, Stuttgart 1978; 57
  • 4 Hansen K, Schliack H. Segmentale Innervation. Ihre Bedeutung für Klinik und Praxis. 2. Auflage. Thieme, Stuttgart 1962
  • 5 Grosser O, Fröhlich A. Beiträge zur Kenntnis der Dermatome der menschlichen Rumpfhaut.  Gegenbauers Morphol Jahrbuch. 1902;  30 508
  • 6 Bolk L. Die Segmentaldifferenzierung des menschlichen Rumpfes und seiner Extremitäten. Beiträge zur Anatomie und Morphologie des menschlichen Körpers. I: Morphol Jahrb 1898; 25: 465. II: Morphol Jahrb 1898; 26: 91. III: Morphol Jahrb 1899; 27: 630. IV: Morphol Jahrb 1900; 28: 105
  • 7 Sherrington C S. Experiments in examination of the peripheral extribution of the fibres of the posterior roots of some spinal nerves, part II.  Philos Trans R Soc Lond (Biol). 1898;  190 45
  • 8 Förster O. Symptomatologie der Erkrankungen des Rückenmarks und seiner Wurzeln. In: Blumke O, Förster O (Hrsg). Handbuch der Neurologie. Band 5. Springer, Berlin 1936; 1-403
  • 9 Keegan J J. Dermatome hypalgesia with posterolateral herniation of lower cervikal intervertebral disc.  J Neurosurg. 1947;  4 115
  • 10 Cotugno D. De ischiade nervosa commentarius. Graffer, Wien 1764
  • 11 Russe O, Gerhardt J, Machacek J, Popp O. Atlas orthopädischer Erkrankungen. Russe O (Hrsg). Huber, Bern 1964
  • 12 Hohmann G, Hackenbroch M, Lindemann K. Handbuch der Orthopädie (Band II) Spezielle Orthopädie, Rumpf (Wirbelsäule und Becken). Thieme, Stuttgart 1958
  • 13 Lanz T, Wachsmuth W. Praktische Anatomie. Rücken (zweiter Band, Siebter Teil), Springer, Berlin 1982; 157-160
  • 14 Gertzbein S D. Degenerative disc disease of lumbar spine, immunological implications.  Clin Orthop. 1977;  123 149-154
  • 15 Kirkaldy-Willis W H. The relationship of structural pathology to the nerve root.  Spine. 1984;  4 49-51
  • 16 Bogduk N. Die Schmerzpathologie der lumbalen Bandscheibe.  Manuelle Medizin. 1992;  30 8-16
  • 17 Howe J F, Loeser J D, Calvin W H. Mechanosensivity of dorsal root ganglia and chronically injured axons: a physiological basis for the radicular pain of nerve root compression.  Pain. 1977;  3 25-41
  • 18 Wall P D, Devor M. Sensory afferent impulses originate from dorsal root ganglia as well as from the periphery in normal and nerve injured rats.  Pain. 1983;  17 321-339
  • 19 Calvin W H, Devor M, Howe J. Can neuralgia arise from demyelination? Spontaneous firing, mechanosensitivity and after-discharge from conducting axons.  Exp Neurol. 1982;  75 755-763
  • 20 Wood S L, Waxman S G. Conducting in demyelinated nerve fibres: Computer simulations of the effects of variation in voltage-sensitive ionic conductances. Proceedings of the 4th Annual Conference of the Institute of Electrical Engineers on Computers in Biological and Medical Research 1982
  • 21 Marks J L. Brain peptides: Is Substanz P a transmitter of pain signals?.  Science. 1979;  205 886-889
  • 22 Olmarker K, Rydevik B, Nordborg C. Autologous nucleus pulposus induces neurophysiologic and histologic changes in porcine cauda equina nerve roots.  Spine. 1993;  18 1425-1432
  • 23 Murata Y, Onda A, Rydevik B, Takahashi K, Olmarker K. Selective inhibition of tumor necrosis factor-alpha prevents nucleus pulposus-induced histologic changes in the dorsal root ganglion.  Spine. 2004;  29 2477-2484
  • 24 Olmarker K, Nutu M, Storkson R. Changes in spontaneous behavior in rats exposed to experimental disc herniation are blocked by selective TNF-alpha inhibition.  Spine. 2003;  28 1635-1641
  • 25 Baron R, Binder A. Is sciatica neuropathic? The mixed pain concept.  Orthopäde. 2004;  33 568-573
  • 26 Friedrich M, Tilscher H, Liertzer H. Manualmedizinische Befunde im Zusammenhang mit der Schmerztopik bei vertebragenen Beschwerden.  Z Rheumatol. 1984;  43 185-189
  • 27 Hippocrates. (470-410 v. Cr.). Librum de affectionibus II. 25, 166 zitiert nach Krämer
  • 28 Head H. On disturbances of sensation with especial reference to the pain of visceral disease.  Brain. 1893;  16 1
  • 29 Rothoerl R D, Woertgen C, Brawanski A. When should conservative treatment for lumbar disc herniation be ceased and surgery considered?.  Neurosurg Rev. 2002;  25 162-165
  • 30 Head H, Campbell A W. The pathology of herpes zoster and its bearing on sensory location.  Brain. 1900;  23 353-523
  • 31 Kortelainen P. Symptoms and signs of sciatic and their relation to the location of the lumbar disc herniation.  Spine. 1985;  10 88-92
  • 32 Cermak T, Friedrich M. Klinische Vorfelddiagnostik beim Schmerzbild „Lumboischialgie”.  Phys Rehab Kur Med. 1999;  9 213-218
  • 33 Vucetic N, Määttänen H, Svensson O. Pain and pathology in lumbar hernia.  Clin Orthop and Rel Research. 1995;  320 65-72
  • 34 Brügger A. Die Erkrankungen des Bewegungsapparates und seines Nervensystems. Fischer, Stuttgart, New York 1977
  • 35 Schmitt O, Fritsch E, Hassinger M, Schmitt E. Epikritische Langzeitergebnisstudie nach lumbalen Bandscheibenoperationen.  Neuroorthopädie. 1984;  2 410-416
  • 36 Bejia I, Younes M, Zrour S, Touzi M, Bergaoui N. Factors predicting outcomes of mechanical sciatica: a review of 1 092 cases.  Joint Bone Spine. 2004;  71 567-571
  • 37 Akkerveeken P F. On painpatterns of patients with lumbar nerve root entrapment.  Neuro-Orthopedics. 1993;  14 81-102
  • 38 Nitta H, Tajima T, Sugiyama H, Moriyama A. Study on dermatoms by means of selective lumbar spinal nerve block.  Spine. 1993;  18 1782-1786
  • 39 Wolff A P, Groen G J, Crul B J. Diagnostic lumbosacral segmental nerve blocks with local anesthetics: a prospective double-blind study on the variability and interpretation of segmental effects.  Reg Anesth Pain Med. 2001;  26 147-155
  • 40 Takahashi Y, Takahashi K, Moriya H. Mapping of dermatomes of the lower extremities based on an animal model.  Neurosurg. 1995;  8286 1030-1034
  • 41 Suzuki N, Tsubouchi S. Segmental (L4-S1) motor and sensory innervation of lower extremity determined by electrical potentials.  Nippon Seikeigeka Gakkai Zasshi. 1989;  63 229-239
  • 42 Nygaard O P, Mellgren S I. The function of sensory nerve fibers in lumbar radiculopathy. Use of quantitative sensory testing in the exploration of different populations of nerve fibers and dermatomes.  Spine. 1998;  23 348-352
  • 43 Bogdok N. The innervation of the lumbar spine.  Spine. 1983;  8 286-293
  • 44 Bogduk N. The lumbar mammillo-accessory ligament. Its anatomical and neurosurgical significance.  Spine. 1981;  6 162-167
  • 45 Kimmel D L. Innervation of spinal dura mater and dura mater of the cranial fossa.  Neurology. 1960;  10 800-809
  • 46 Groen G, Baljet B, Drukker J. The nerves and nerve plexuses of the human vertebral column.  Am J Anat. 1990;  188 282-296
  • 47 Groen G, Baljet B, Drukker J. The innervation of the spinal dura mater: Anatomy and clinical implications.  Acta Neurochir. 1992;  92 39-46
  • 48 Bogduk N. The Innervation of intervertebral disks. In: Gosh P (ed). The biology of intervertebral disk. Vol. I. CRC press, Boca Raton 1988; 135-149
  • 49 Yoshizawa H, O'Brian J P, Thotna-Smith W, Trumper M. The neuropathology of intervertebral discs removed for low back pain.  J Path. 1980;  132 95-104
  • 50 Bogduk N. The lumbar disc and low back pain.  Neurosurg Clin North Am. 1991;  2 791-806.
  • 51 Bogduk N, Aprill C, Derby R. Discography. In: White A H (ed). Spine care, volume one: diagnosis and conservative treatment. Mosby, St. Louis 1995; 219-138
  • 52 Moneta G B, Videmann T, Kaivanto K, Aprill C, Spivey M, Vanharanta H, Sachs B L, Guyer R D, Hochschuler S H, Raschbaum R F, Mooney V. Reported pain during lumbar discography as a function of annular ruptures and disc degeneration. A reanalysis of 833 discogramms.  Spine. 1994;  17 1968-1974
  • 53 Kniesel B. Lumbar discogenic pain.  Z Orthop. 2004;  142 709-715
  • 54 Schwarzer A B, Aprill C N, Derby R, Fortin J, Kine G, Bogduk N. The prevalence and clinical features of internal disc disruption in patients with chronic low back pain.  Spine. 1995;  20 1878-1883
  • 55 Crock H V. Internal disc disruption: a challenge to disc prolaps 50 years on.  Spine. 1986;  11 650-653
  • 56 Aprill C, Bogduk N. High intensity zone: a pathognomic sign of painful lumbar disc on MRI.  Brit J Radiol. 1992;  65 361-369
  • 57 Keller R B, Atlas S J, Singer D E. et al . The Maine lumbar spine study: I. Background and concepts.  Spine. 1996;  21 1769-1776
  • 58 O'Neill C W, Kurgansky M E, Derby R, Ryan D P. Disc stimulation and patterns of referred pain.  Spine. 2002;  27 2776-2781
  • 59 Horal J. The clinical appearence of low back disorders in the city of Gothenburg, Sweden.  Acta Orthop Scandinav. 1969;  (Suppl) 118 1-108
  • 60 Mooney V. Where is the pain coming from?.  Spine. 1987;  12 754-759
  • 61 Deyo R A, Tsui-Wu Y J. Descriptive epidemiology of low back pain and its related medical care in the United States.  Spine. 1987;  12 264-268
  • 62 Jensen N. Magn. res. imag. of the lumbar spine in people without back pain.  N Engl J Med. 1994;  331 69-73
  • 63 Boden S D, Davis D O, Dina T S, Patronas N J, Wiesel S W. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation.  J Bone Joint Surg Am. 1990;  72 403-408
  • 64 Hildebrandt J. Does unspecific low back pain really exist?.  Z Orthop. 2004;  142 139-145
  • 65 Ito T, Homma T, Uchiyama S. Sciatica caused by cervical and thoracic spinal cord compression.  Spine. 1999;  24 1265-1267
  • 66 Ljunggren A. Descriptions of pain and other sensory modalities in patients with lumbago-sciatica and herniated intervertebral discs. Interview administration of an adapted McGill pain questionnaire.  Pain. 1983;  16 265-276
  • 67 Brismar H, Vucetic N, Svensson O. Pain patterns in lumbar disc hernia drawings compared to surgical findings in 159 patients.  Acta Orthop Scand. 1996;  67 470-472
  • 68 Uden A, Landin L A. Pain drawing and myelography in sciatic pain.  Clin Orthop. 1987;  216 124-130
  • 69 Ohnmeiss D D, Vanharanta H, Ekhol J. Relationship of pain drawings to invasive tests assessing intervertebral disc pathology.  Eur Spine J. 1999;  8 126-131
  • 70 Brodal A. Neurological Anatomy In Relation To Clinical Medicine. Oxford University Press, New York, Oxford 1980
  • 71 McKenzie R, May S. The Lumbar Spine: Mechanical Diagnosis and Therapy. 2 vols. Spinal Publications, Waikanae, New Zealand 2003
  • 72 Skytte L, May S, Petersen P. Centralization: its prognostic value in patients with referred symptoms and sciatica.  Spine. 2005;  30 E293-E299
  • 73 Vucetic N, Svensson O. Physical signs in lumbar disc hernia.  Clin Orth. 1996;  1 192-201
  • 74 Lebkowski W J. Presence and intensity of the Lasegue sign in relation to the site of lumbar intervertebral disc herniation.  Chir Narzadow Ruchu Ortop Pol. 2002;  67 265-268
  • 75 Vroomen P C, de Krom M C, Knottnerus J A. Diagnostic value of history and physical examination in patients suspected of sciatica due to disc herniation: a systematic review.  J Neurol. 1999;  246 899-906
  • 76 Spencer D L. The anatomical basis of sciatica secondary to herniated lumbar disc: a review.  Neurol Res. 1999;  21 (Suppl 1) S33-S36
  • 77 Yuan P S, Booth R E, Albert T J. Nonsurgical and surgical management of lumbar spinal stenosis.  Instr Course Lect. 2005;  54 303-312
  • 78 Kostuik J P, Harrington I, Alexander D, Rand W, Evans D. Cauda equina syndrome and lumbar disc herniation.  J Bone Joint Surg [Am]. 1986;  68 386-391
  • 79 Barriga A, Villas C. Cauda equina syndrome due to giant disc herniation.  Rev Med Univ Navarra. 2002;  46 33-35
  • 80 Eysel P, Rompe J D, Hopf C. Prognostic criteria of discogenic paresis.  Eur Spine J. 1994;  3 214-218
  • 81 Dubourg G, Rozenberg S, Fautrel B, Valls-Bellec I, Bissery A, Lang T, Faillot T, Duplan B, Briancon D, Levy-Weil F, Morlock G, Crouzet J, Gatfosse M, Bonnet C, Houvenagel E, Hary S, Brocq O, Poiraudeau S, Beaudreuil J, de Sauverzac C, Durieux S, Levade M H, Esposito P, Maitrot D, Goupille P, Valat J P, Bourgeois P. A pilot study on the recovery from paresis after lumbar disc herniation.  Spine. 2002;  27 1426-1431
  • 82 Postacchini F, Giannicola G, Cinotti G. Recovery of motor deficits after microdiscectomy for lumbar disc herniation.  J Bone Joint Surg [Br]. 2002;  84 1040-1045
  • 83 Ng L C, Sell P. Predictive value of the duration of sciatica for lumbar discectomy. A prospective cohort study.  J Bone Joint Surg [Br]. 2004;  86 546-549
  • 84 Vroomen P C, de Krom M C, Knottnerus J A. Predicting the outcome of sciatica at short-term follow-up.  Br J Gen Pract. 2002;  52 119-123

Dr. Peter Machacek

Orthopädisches Spital Wien Speising

Speisingerstraße 109

1130 Wien

Österreich

Phone: 00 43/1/80 18 22 97

Email: peter.machacek@oss.at

    >