Behandlung des lumbalen Bandscheibenvorfalls - evidenzbasierte Praxis
http://www.ncbi.nlm.nih.gov/pubmed/20689695
Abstract
CLINICAL QUESTION: What is the best treatment for lumbar disc herniations? RESULTS: For patients failing six weeks of conservative care, the current literature supports surgical intervention or prolonged conservative management as appropriate treatment options for lumbar radiculopathy in the setting of disc herniation. Surgical intervention may result in more rapid relief of symptoms and restoration of function. IMPLEMENTATION: While surgery appears to provide more rapid relief, many patients will gradually get better with continued nonoperative management; thus, patient education and active participation in decision-making is vital.
S213: Treatment
"Initial treatment can begin with a short course of rest as
indicated for the patient with acute lumbar radiculopathy in
the setting of a lumbar disc herniation. Pain management may
include either a prescription for a moderate nonsteroidal antiinflammatory,
such as ibuprofen 800 mg every eight hours as
needed, or tramadol 50 mg every 4–6 hours as needed. Patients
with more substantial pain can be treated with mild narcotic
pain medication, such as hydrocodone-acetaminophen
5 mg/500 mg every 4–6 hours on an as-needed basis. Physical
therapy referral can be made at the initial office visit, to
include mild stretching and pain relief modalities, such as
ultrasound, whirlpool, ice and heat pack therapy, electrical
stimulation, and/or massage. Those individuals found to
have perineal anesthesia, an incompetent rectal sphincter, or
significant neurologic deficits by examination should be sent
to the emergency room or have an urgent consultation with a
surgeon. Those with significant, but stable, sensory or motor
deficits may be referred to a spine surgical specialist on an
urgent basis. Individuals with a history of more than six months
of persistent symptomatology can be referred to a spinal
surgeon without consideration for conservative management,
because surgical results have been shown to deteriorate after
6–12 months of persistent symptomatology.12
Patients who have failed a short course of conservative
management (ie, 3–4 weeks) can be considered candidates
for epidural steroid injection. Those who have failed six
weeks of conservative management and/or derived no relief
from steroid injection, may consult with a spine specialist as a routine referral.
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