Artikel
How do referred pain syndromes influence the outcome after lumbar discectomy?
Inwieweit beeinflussen pseudo-radikuläre Schmerzbilder das Ergebnis nach lumbaler Bandscheibenoperation?
Suche in Medline nach
Autoren
-
M. Knöringer
- Neurochirurgische Klinik und Poliklinik der TU München, Klinikum rechts der Isar
-
S. Seidl
- Neurochirurgische Klinik und Poliklinik der TU München, Klinikum rechts der Isar
-
A. Frank
- Neurochirurgische Klinik und Poliklinik der TU München, Klinikum rechts der Isar
-
F.X. Weinzierl
- Neurochirurgische Klinik und Poliklinik der TU München, Klinikum rechts der Isar
-
A.E. Trappe
- Neurochirurgische Klinik und Poliklinik der TU München, Klinikum rechts der Isar
| Veröffentlicht: | 8. Mai 2006 |
|---|
Gliederung
Text
Objective: After lumbar discectomy up to 70% of patients suffer from incomplete remission of pain in the months following the procedure. Recurrence or scar tissue could cause persistent radicular pain and revision surgery is required in 4 to 10% of the cases. However, most patients complain about low back pain and pain with pseudoradicular irradiation. The purpose of this study was to analyze the role of referred pain syndromes after lumbar discectomy.
Methods: In a prospective study we included 304 Patients (143 Women and 161 men) with a mean age of 47 years, who underwent a lumbar discectomy after having been diagnosed with an uncomplicated intervertebral disc herniation. Prolaps occurred in 51% of the cases at the level L5/S1, at L4/5 in 40% and at the level L3/4 in 5, 9% of the cases. Operative procedure included laminotomy, sequesterotomy and discectomy. The clinical examination of the patients was performed 2 month post intervention.
Results: the time of the examination 73% of the Patients voiced no complaints, while 27% showed persistent pain syndromes. In this group 60% displayed pain with pseudoradicular pain irradiation and 40% with radicular pain. Women dominated the pseudoradicular pain group (1,45:1) and men the radicular pain group (3,1:1). In the pseudoradicular pain group the origin of pain was found to be located in the musculus erector trunci (44, 9%), the sacro- iliac joint (6, 3%), gluteus medius muscle (16, 3%), major trochanter (8, 2%), myogelosis (6, 3%) and a combination in 18, 4%. Pain intensity measured by the VAS scale showed in the patient group with pseudoradicular pain a 2, 8 times greater intensity than in the group displaying radicular pain.
Conclusions: Pseudoradicular pain can be a causal factor underlying for a poor postoperative result, concerning persistent pain syndromes and patient satisfaction. In the case of postoperative pain a profound clinical examination is important to determine the influence of referred pain syndromes, because treatment options are very effective including many low risk therapies like infiltrations or soft manual techniques.
