In order to be able to treat osteoarthritis better, you should also know in advance what exactly osteoarthritis is and how it is produced. The arthrosis deformans, which is conceptually translated from the ancient language elements “joint” and “mutilation” and thus also historically documented earlier, is now defined as the “overcoming joint wear”.
Not infrequently, the treating physician of a “back patient” after unsuccessful conservative pretreatment also need to inform about a necessary and more extensive “invasive and / or surgical procedures” and decide on further measures with his entrusted patient.
When a layperson hears about spinal surgery, at first, there is usually a strong and legitimate discomfort. The general idea that these are high-risk interventions is still widespread. In contrast, spine surgery has made tremendous progress over the last decade. While in the eighties and nineties stiffenings with large surgical scars and long hospital stays were the order of the day, today most interventions can be performed on an outpatient basis with surgical scars. under 1cm.
This is especially due to two facts. On the one hand, new biomaterials, surgical techniques and implants have come on the market, on the other hand, interdisciplinary centers have increasingly emerged outside hospitals, offering the full range of conservative treatment and minimally invasive surgery. From diagnostics to the right therapy, practically everything is in one hand and targeted individualized step therapy can be carried out.
For example, today many herniated discs can be shrunken in an outpatient setting after a few minutes of local anesthesia in case of conservative therapy failure. The success rates are higher here than with conventional open therapy. If there is a major herniated disc with nerve failures, using a microscope this is also often removed on an outpatient basis. At the same time, a protective film is placed around the nerve, which reduces scarring and pain and prevents the risk of a new herniated disc. Even simple fractures of the spine, which used to be tediously treated with corsets for 3 to 6 months, are stabilized today by an outpatient procedure in which a biomaterial is injected into the vertebra under local anesthesia.
Patients are immediately fit for work and sport. Also in chronic problems of the spine such. Nerve narrowing in the cervical or lumbar spine areas makes it possible today to avoid major surgery and stiffening, and to insert implants that correct the problem and preserve the mobility of the spine. The principle here is the following: Not by a stiffening, but by targeted treatment of the cause of pain with the smallest possible intervention to treat the pain. Of course, it can happen that the corresponding segment has to be stiffened if there is a significant amount of eddy gliding. However, there are also keyhole techniques today that allow for immediate mobilization and early release, often after a few days. Furthermore, a better interdisciplinary networking in special centers ensures that other causes of spinal complaints are recognized in good time and specifically treated. This avoids unnecessary surgery and overall allows for the success rate of spinal surgery (which is properly selected today at up to 90%).
In summary, modern spine surgery has lost much of its horror. The old saying, “stiffen is better,” has been replaced by the finding “less is more” to maintain mobility, to restore work and sports ability through a possible outpatient or short-term surgery and, above all, the potential risks minimize.
Here once in short form some of the most important vertebral column interventions.
I. The Minimally Invasive Methods: Facet Infiltration / Nerve Root Blocking / Peridural Injection and Catheter Techniques with Anti-inflammatory / Analgesic Materials
II. Intervertebral disc procedure: minimally invasive / endoscopic with and without additional concomitant surgical procedures / means.
III. Stiffening operations / intervertebral disc prostheses and other movement segment affecting surgical procedures
But even with surgical procedures is usually a fundamental change of the so-called.
“Back consciousness” in the sense of a so-called “back school” very important and necessary for sustainable therapeutic success. And despite or even because of a successful spinal surgery, it is imperative to “always do something yourself” for his back.
And IMPORTANT: to find the right therapeutic method at the right time individually is the high art of the supervising physician / therapist and above all the order “to look after” his / her patient / customer optimally even without economic constraints.
The bike is number one as a means of transport and runs other means of transport from the rank. In Germany alone there are approximately 80 million bicycles estimated. Tendency increasingly increasing. Cycling is known to be healthy and therefore fully in the health trend.
And the conditions are optimal for this. The saddle carries a large part of the weight and with the correct position on the wheel, joints, ligaments and tendons are spared. At the same time, the muscles gain momentum through the smooth movement, the cardiovascular system is required and the condition is trained. The quality of life is sustainably improved and it helps to “general recovery”. Cycling thus improves endurance, strength, flexibility, balance, responsiveness and offers the experience in a change of relaxation and physical challenge and then all in the wild.
Usually the short stay in draft, the too heavy shopping bag or the famous “wrong movement”, and already the pain is there. In such a situation, most people want only one thing: to move as quickly as possible without pain. If then the emergency medication, the hot water bottle and the “always good special tip of the neighbor” does not help any more or the complaints deteriorate even goes to the specialist. And not infrequently, the doctor can do just that with a targeted syringe in the “right place and at the right time”, and interrupt this pain cycle. The injection is actually not as bad as their reputation. If they do not, like many others, know of good and bad experiences from the past, it replaces a causal and fundamental necessary treatment concept. However, not every syringe is the same, even if this is often generalized with the patient and also the doctor. Is it a muscle hardening, tendon tension or rather a nerve root irritating disc herniation? Do the pain out or are they restricted to a particular area? Is the pain dull, piercing, or rather tearing? These and many other questions will make a good doctor and also take into account other necessary aspects (illnesses / injuries / medicines, etc.) before he canal the cannula. As a rule, a general, systemically effective “universal syringe” with pain relievers, muscle relaxants and anti-inflammatory agents is often successfully used by the GP. But not only the ingredients, but also the location and type of injection, vary according to the medical indication. The four most important “targeted special injection forms” are compiled here briefly and informatively.
Neuraltherapy – After physical exertion / maladjustment or even unusual cold / drafts, a muscular hardening of the muscles can occur, which can not be overcome by careful movement (eg acute skew). Through the targeted injection of a local anesthetic into certain skin points or in the vicinity of muscle and nerve cords, a pain-alleviating and muscle-relaxing effect is achieved. Also, specific other additives may be added to potentiate / stabilize the effect. When the effect of the syringe decreases, the trigger of the direct complaints usually disappears, so that no further causative therapy is necessary.
The nerve root blockade- A nerve root blockade is performed, for example, in patients with (sub) acute lumbar disc disc prolapse. In this case, a local anesthetic or cortisone is sprayed directly onto the nerve root, which is impacted by the preceding intervertebral disc tissue. The pain usually occurs immediately, but short-term deafness in the leg may occur (depending on the location of the affected nerve root). The cause of the complaints is however not eliminated; There will almost always be a need for intensive, conservative treatment, as well as surgery.
The epi (peri) durale injection- An injection into the space between the spinal cord skin. It is used for the treatment of such disc disc protrusions or incisions, in which a constriction of the spinal canal arises due to the inflammation-induced swelling of one or more nerve roots. In addition to a local anesthetic and cortisone, a saline solution is often injected, which also reduces the swelling due to the natural osmosis effect. Depending on the location of the symptoms, the epidural injection is either directly between two vertebrae or as a sacral injection through a natural opening at the coccyx.
The Facet Infiltration – Sometimes it is not the nerve roots, but the small vertebral joints (facets), which are innervated with a lot of nerves, from which the pain emanates. The reason for this can be a wear-induced osteoarthritis, but also irritation due to too great mobility of the vertebrae, caused by a loosening of the capsule / tape apparatus. The facets themselves can then be sprayed with an anesthetic or cortisone. This injection is carried out by an anatomically well-trained and experienced physician also “freehand” with orientation to anatomical “landmarks”, ie well palpable parts of the spine. Sometimes, however, the injection of the syringes also requires targeted placement under ultrasound / CT / X-ray control.
As already mentioned, the so-called rapid syringe “does not treat the cause, but usually only, but often very successfully, the main symptom: the pain. And with pain, most of the necessary measures can not be properly and adequately addressed. The causative therapy should always be kept in mind by the patient and also by the physician, and then promptly and qualitatively in the short / medium term. In the case of a simple blockage / tension, the massage, chirotherapy and / or manual therapy can be used; in the case of more extensive problems, the general and special physiotherapy is used as basic therapy. But also various electro- / thermostimulative measures and special associations (Kinesiotape, etc) can support the applications. But usually a basic holistic change of the back consciousness in the sense of a so-called “back school” is absolutely necessary to become long-term complaint-free.
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– Alternative biological processes for the treatment of back pain.
A worn disc as biological essential consequence of aging and / or miscarriage / congestion with resulting back pain, affecting nearly everyone in our modern society. If no acute herniated disc with nerve loss and severe pain, the symptoms are usually chronic, often increasing and then to remain stable for years. Ultimately, then very quickly carried out the various invasive and costly surgical procedures with a high surgical risk, and with serious consequences risks to a failing individually required conservative treatment strategy.
Open procedures for decompression with / without metal reinforcement or a mechanical disc prosthesis can be performed. For decades, researchers have tried to slow the degenerative disc disease or prevent. This is the future of these individual biological method to avoid surgery, is undisputed even in conservative WS specialists. Experiments with isolated disc cells to propagate them outside the body and to “regenerate” have not brought the desired results, as these cells die in the worn disc within a short time, rather than to survive.
Here in the future most likely stem cells that are genetically modified to be able, in a “supply desert”, that is, the degenerated disc to survive. However, use of this therapy is unlikely in the next decade. What there is thus at present, in order to reduce the complaints of the patient? Outside the known painkillers, the usual conservative therapy or surgical methods known biological therapies are increasingly brought to the fore in recent years. Unmodified stem cells have achieved initial good results, but implementation is in the width too expensive and there have yet further studies are conducted. In addition to the biologically active Nucleoplasty technology (the reduction of local inflammation than desired side effect). With / without combination of PRP (Platelet Rich Plasma) led by injection into the intervertebral disc isolated to improve the complaints a problem of all these process is the fact that the mechanical component of the intervertebral disc, i.e., buffering and pressure distribution, solely by cells can not be restored.
Therefore alone the combination therapy of cells and a biocompatible material to restore the buffer function will be successful in the future well. Many materials are diesbzgl. been studied in the past 15years in studies and almost all have been rejected. Demanded here are a biological compatibility as possible with minimal operation expenses / costs, persistent buffer function. It has up to now only be able to enforce a material that meets all of these necessary conditions. This new biological outpatient procedure with no side effects is a hydrogel stick (s. Fig.), Which is inserted with a needle under local anesthesia on an outpatient basis in the disc.
This hydrogel swells after 1- 2 hours to ten times, and therefore the rehydrated disc, whereby it can again perform its natural function buffer. In addition, this biomaterial fulfills a further important requirement, because it carries out the regulation of the pH value to a reduction of the inflammation in the disc, which in turn is important for the survival of cells. And in combination with stem cells and / or PRP ermöglichensich additional new biologically active outpatient combination method here. It seems that this small operation that has been performed on more than 500 patients and more recently in selected European countries (as well as Mallorca) was introduced, which is probably best minimally invasive biological processes with worn discs at the present time.
The surgery under local anesthesia on an outpatient basis takes an average of just a few minutes and the patient is from the next day again work and sport capable.
Currently, clinical results are (without cells) for the lumbar spine, as well as the cervical spine of up to two years ago, in favor of the biomaterial; if the problem with this therapy is also solved in the long term remains to be seen. At least from today’s perspective, the use of a hydrogel with / without cell medium to long term the most promising when major surgeries with long hospitalization, as stiffening or mechanical intervertebral disk prosthesis, to be moved in the longer term or avoided.
Informations at MEDISPORT team of Dr Seita Mallorca
<img class="img-resize alignright size-full wp-image-669" src="http://www.medisport-mallorca.com/wp-content/uploads/2015/12/PRP-Gelenk-1.16.jpg" alt="PRP Gelenk 1.16" width="396" height="397" srcset="http://www.medisport-mallorca.com/wp-content/uploads/2015/12/PRP-Gelenk-1.16.jpg 396w, http://www.medisport-mallorca.com/wp-content/uploads/2015/12/PRP-Gelenk-1.16-150×150.jpg 150w, http://www.medisport-mallorca.com/wp-content/uploads/2015/12/PRP-Gelenk-1.16-300×300.jpg 300w, http://www.medisport-mallorca simvastatin 20 mg tablet.com/wp-content/uploads/2015/12/PRP-Gelenk-1.16-50×50.jpg 50w, http://www.medisport-mallorca.com/wp-content/uploads/2015/12/PRP-Gelenk-1.16-45×45.jpg 45w” sizes=”(max-width: 396px) 100vw, 396px” />–Moderne medizinische regenerative Verfahren– Eigenblut-Biostimulation mit thrombozytenreichem Plasma
II.Anwendungen beim Problemen rund um den Bewegungsapperat!
Mit Tendenz in der modernen Medizin zur Regeneration von defekten Geweben etablierte sich zusehends die Platelet-rich Plasma –PRP- Therapie. Da der engagierte Mediziner sich dort immer gehäufter mit den Überanstrengungen/Verletzungsformen und Abnutzungserscheinungen der verschiedensten Gewebetypen beschäftigen muss, ist dieser natürlich immer auch auf der Suche nach Alternativen und/oder unterstützende Heilungsverfahren.
Genetische Vorgaben, aber auch Alterungsprozesse und Mikro-und Makroverletzungsfolgen, sowie chronische Überlastungen verschiedenster Gewebestrukturen mit den Folgen eines kontinuierlichen Abbaus bei meist inkompletten natürlichen Eigenheilung führen zu starken Schädigungen .Diese in fast allen anderen bindegewebliche Strukturen (Knorpel/Sehnen/Muskeln/Haut/Bindegewebe/etc) in Dysbalancen stattfindenden negativen Prozesse fördern einen kontinuierlichen Verschleißprozeß.
Immer wieder kommt es dort zu Entzündungen und Aktivierung der schädlichen direkten lokalen Prozesse und auch inkompletten Reparaturen. Wie läuft die Herstellung von körpereigenen Wundheilungsfaktoren aus Blutplättchen-PRP-Therapie eigentlich ab? Es wird eine kleine Menge Blut aus einer Vene entnommen um anschließend in einem speziellen Trennverfahren körpereigene regenerative, antientzündliche Bestandteile zu konzentrieren. Die so gewonnene körpereigene Lösung wird eventuell dann je nach Anwendung und Ziel noch mal aufgearbeitet, um dann aber unmittelbar in das entsprechende Gewebe mit spezieller Technik injiziert zu werden. Das dabei strenge sterilen Bedingungen und anatomische Kenntnisse vorausgesetzt werden, versteht sich von selbst um bei höchstmögliche Sicherheit den gleichzeitig größtem medizinischem Therapieerfolg zu erreichen. Da dann praktisch auch keine sog. Nebenwirkungen bekannt sind, steht dem innovativen Arzt mit dieser Therapieoption ein hochwirksames natürliches Verfahren zur Verfügung. Die Indikationen aus der Human-, Zahn- und Veterinärmedizin sind daher sehr vielfältig. In der Orthopädie sind das neben Sehnen-Muskelerkrankungen /-Verletzungen, Frakturbehandlung, Knorpelregeneration. Diese ersetzt zusehends die Anwendungen von Kortison und schon immer sehr fraglichen Kombinationen von Naturheilstoffen und wird auch des Öfteren in Kombination mit Hyaloron verwendet. Neben den bewährten Anwendungen in der Zahnheilkunde auch zusehends immer mehr Anwendungen in der Chirurgie (Wundheilungsstörungen /-Förderungen) . Auch kommen dermatologischen und kosmetischen-ästhetischen Behandlungskonzepten zum tragen .Und selbstverständlich auch in jeder anderen Region, wo Zellregeneration über eine verbesserte Kollagensynthese eine Anregung der Hauterneuerung /Unterhautzellen Stimulation erwünscht ist. Durch die pluripotenten Eigenschaften wird PRP alleine und/oder in Kombinationen mit Eigenfett/Hyaluron/ u.a. Stoffen, etc. eingesetzt. Dabei ist eine Verbesserung des Hautbildes, Hautstraffung, Faltenglättung an jedem gewünschten Körperbereich absolut möglich. Auch Volumenaufbau in Kombination mit Eigenfett/Stammzellen findet zunehmende Anwendungen. Auch zeigt sich eine langfristige bleibende Stimulation des Haarwuchses(Alopezie) und auch deutliche Heilungsbeschleunigung bei kritischen Wunden-/ Narbenbehandlungen(Verbrennungen/Hauttransplantationen/M.Dypytren&Ledderhose) unter PRP Anwendungen. Es bleibt zu hoffen das dieser auch zukünftige nachhaltige Trend zur natürlichen und regenerativen Medizin nicht von ungeschulten „Gesundheitsspezialisten“ und medizinischen „Alleskönnern“ mit falschen Versprechungen und insbesondere falschen Behandlungen mit unakzeptablen Preisgestaltungen, kaputt gemacht wird. Auf eine absolute professionelle Seriosität, laufende Fortbildungen und eine gute medizinische Aus-& Weiterbildung Kompetenz sollte jeder „Kunde/Patient“ bei dem Therapeuten seiner Wahl voraussetzen.