Reith W, Yilmaz U
Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße 1, 66421, Homburg/Saar, Deutschland.
Radiologe. 2011 Sep;51(9):791-6. doi: 10.1007/s00117-011-2148-4.
As a rule vertebroplasty and kyphoplasty can prevent further collapse of a previously broken vertebra. Pain is probably caused by collapse of the porous bone resulting in instability of the vertebra. Stabilization of the vertebra by injecting cement results in a clear improvement in the complaint and a clear reduction in pain resulting in better mobilization. Recent results have, however, cast doubt on the effectiveness of this therapy. Diagnostic nerve blocks on the spinal column are important because the pain is mostly clinically uncharacteristic, the innervation is complex and the pain is subjective. An exact classification can be made using special nerve blocks. Prerequisites for the use of diagnostic nerve blocks are an extensive clinical history and examination of the patient before nerve blocks are carried out. In approximately 15-45% of patients the zygapophyseal joint is the cause of the back pain. Anesthesia of the zygapophyseal joint can be carried out by direct intra-articular application of a local anesthetic or by a block of the medial branch of the posterior branch of each of two spinal nerves. The simplest method is by computed tomography-guided zygapophyseal block.
通常情况下，椎体成形术和后凸成形术可以防止先前骨折的椎体进一步塌陷。疼痛可能是由多孔骨塌陷导致椎体不稳定引起的。通过注入骨水泥来稳定椎体，可明显改善症状并显著减轻疼痛，从而使活动能力增强。然而，近期的研究结果对这种治疗方法的有效性提出了质疑。脊柱的诊断性神经阻滞很重要，因为这种疼痛在临床上大多没有典型特征，神经支配复杂且疼痛具有主观性。使用特殊的神经阻滞可以进行准确的分类。使用诊断性神经阻滞的前提条件是在进行神经阻滞之前要有详尽的临床病史并对患者进行检查。在大约15%至45%的患者中，关节突关节是背痛的原因。关节突关节麻醉可通过在关节内直接注射局部麻醉剂或通过阻滞两条脊神经后支的内侧支来进行。最简单的方法是计算机断层扫描引导下的关节突阻滞。
