[Minimally invasive injection therapy in lumbar syndromes]

[Injection treatment for cervical and lumbar syndromes: principles, indications and general performance]

An intensive conservative treatment that exhausts all treatment options should fundamentally be carried out before every surgical intervention in the region of the spinal column. The therapeutic measures are determined by the extent of the cervical or lumbar syndrome. As a rule, in cases of local complaints symptomatic measures with physiotherapy or digital healthcare applications are indicated. In cases of referred cervical and lumbar syndromes targeted injections can be employed. Before targeted injection treatment a detailed orthopedic clarification with respect to the intensity of local, radicular or pseudoradicular complaints must be carried out. When carrying out minimally invasive injection treatment specific prerequisites with respect to spatial, personnel and technical conditions must be fulfilled. The indications and contraindications must be strictly controlled.

[Application of image-guided injection for cervical and lumbar syndromes]

The X‑ray image-guided injection methods are an important tool for the treatment of cervical and lumbar pain syndromes. For the application of these methods it is necessary to have a differentiated consideration of cervical and lumbar pain syndromes. This leads to a decoding of complaints to assignable pain generators, which enables a targeted injection method. Depending on the origin of pain, injections are placed at the nerve root or the joints. Thus, the vicious cycle of pain can be stopped. A correct technical procedure is of enormous importance. Particular attention must be paid to the pharmacological effects and special complications. A monitoring and precautionary measures are mandatory.

[Injection therapy for cervical and lumbar syndromes]

In cervical and lumbar pain syndromes special injections are key for effective pain therapy. Depending on the origin of pain injections are placed at the nerve root or the joints. Thus, the vicious cycle can be stopped. A correct technical procedure is of enormous importance. Because pharmacological effects and special complications are possible, monitoring and precautions are mandatory.

[Injection therapy of cervical spine syndromes]

In cervical spine syndromes, specific injections can reach the pain focus or diminish the nerve root irritation, thus overcoming the vicious circle. Indications, contra-indications, complications, the exact procedure of placing the needle, and the combined use with conservative treatment must be taken into consideration.

[Injection techniques in the cervical spine]

Spinal injections are a treatment option in the conservative management of degenerative spinal disorders. The indications must be critically reviewed for every patient. Treatment with injections for painful spinal disorders should be a part of interdisciplinary treatment regimes. The diagnostic value varies between injection procedures. A large number of imaging techniques are used to achieve a precise and safe needle placement in interventional procedures. The following article presents an overview of common fluoroscopy-guided spinal injection techniques for the cervical spine.

[Selected interventional methods for the treatment of chronic pain : part 2: regional anesthetic techniques close to the spinal cord and neuromodulative methods]

Approximately 5-8 million people in Germany suffer from chronic pain and some patients can profit from specific interventional techniques. In detail these are regional anesthetic techniques close to the spinal cord, neuromodulation, blocks of the sympathetic chain and peripheral nerve blocks. Part 2 of the article presents regional anesthetic techniques close to the spinal cord and neuromodulative methods. Regional anesthetic techniques close to the spinal cord are of high importance for the treatment of chronic low back pain although the efficiency is highly disputed due to the lack of evidence. Neuromodulation includes amongst others intrathecal pharmacotherapy and spinal cord stimulation, which are used for highly selected patients and can lead to very good results for these patients.

[Clinical pathway - conservative back pain treatment]

Back pain is a very common clinical picture. The causes are often not only somatic, which generally has led to a biopsychosocial understanding of this disease. Therefore, it is necessary to employ a multimodal treatment approach to achieve effective and longer-lasting relief. Such a concept requires the cooperation of multiple disciplines in a sophisticated and strongly organized manner. In our clinic we have developed a clinical pathway for conservative back pain treatment that avoids the use of too much time by careful coordination of the therapy elements. It has proven to be a successful tool for the efficient treatment of patients with primarily somatically caused back pain. The following article describes this clinical pathway.

[Concepts of in-patient gradual diagnostics for patients with lumbar back-pain]

Concepts for treating back pain by considering recent advancements in understanding chronic pain have been increasingly discussed over the last years. In general, any kind of therapy requires a most accurate diagnosis; however, in cases of lumbar back pain matching clinical observations with known structural pathologies is not always straight forward. Here, we suggest a concept of in-patient gradual diagnosis of patients with back pain that includes stepwise structural and functional components. We emphasize that in addition to the specific (classifiable) factors causing back pain (e.g. compression of lumbar nerve roots, facet joint associated pain syndrome, sacroiliacal dysfunction, segmental instability) also unspecific (non-classifiable) causes as well as disease-associated and/or determining bio-psychological or social factors need to be considered. With this study, we aim to introduce the procedure and assess the value of in-patient gradual diagnostics. We will describe different approaches, which we will evaluate for specific indications.

[Minimally invasive injection therapy for patients with radicular lumbar spine syndrome. First results of an minimally invasive treatment for patients with lumbar radiculopathy]

BACKGROUND

There are few studies on minimally invasive injection therapy (MIT) combined with multimodal conservative therapeutic options. Here, we evaluate the results of MIT in a clinical study.

METHODS

A total of 61 patients with radicular lumbar symptoms treated with MIT were examined before and 14.5 months after treatment. Subjective, objective, clinical and anamnestic parameters were considered.

RESULTS

In most cases, protrusions and prolapses were seen. Radicular pain, sensible and motoric deficits and also functionality of the spine could be rectified after MIT. No major complications were seen during treatment.

CONCLUSION

MIT is an effective approach with few complications for the treatment of patients with radicular syndromes.