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Therapeutische Möglichkeiten – interventionelle und operative Verfahren

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Praxis LWS-Erkrankungen

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Zusammenfassung

Die Wirbelsäule entsteht aus der Chorda dorsalis. Die Chorda bildet den späteren Gallertkern der Bandscheiben. Bei Geburt ist die Wirbelsäule in ihrer Anlage voll entwickelt. Vor dem 4. Lebensjahr ist die Bandscheibe bis in den äußeren Faserring vaskularisiert. Nach dem 4. Lebensjahr erfolgt die Ernährung der Bandscheibe ausschließlich per Diffusion, Gefäße sind dann nicht mehr nachweisbar. Die Wirbelsäule durchläuft einen natürlichen Alterungsprozess. Schon mit dem 30. Lebensjahr treten beim Menschen physiologischerweise degenerative Veränderungen der Bandscheibe auf. Der Nucl. pulposus hat einen hohen Proteoglykan- und damit einen hohen Wassergehalt. Bei der kindlichen Bandscheibe liegt der Wassergehalt bei 90%, dieser nimmt im Alter auf ca. 70% ab (Gower u. Pedrini 1969). Er ist von einem kräftigen Anulus fibrosus und von Poren enthaltenden kartilaginären Endplatten umgeben. Nach innen verlaufen die Fasern in einem Winkel von ca. 60°, wodurch die Wirbelsäule eine wesentliche Stabilität für Rotationsbewegungen erhält (Krismer et al. 1997). Der intradiskale Ruhedruck einer intakten Bandscheibe beträgt ca. 500 kPa, kann aber in Abhängigkeit von der Belastung bis auf 2300 kPa ansteigen (Eysel et al. 2000, Wilke et al. 2001). Unter Belastung verliert die Bandscheibe Wasser, der osmotische Druck nimmt umgekehrt proportional zur Belastung zu (Kolditz et al. 1985).

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Authors and Affiliations

  1. Klinik für Konservative und Operative Wirbelsäulentherapie, Kliniken Dr. Erler GmbH, Kontumazgarten 4–18, 90429, Nürnberg

    Priv.-Doz. Dr. med. Bertram Böhm

  2. KKH Rheinfelden Orthopädie, Vogelsang 4, 79618, Rheinfelden

    Dr. med. Andreas Lange

  3. Hirslanden-Klinik Birshof, Reinacherstrasse 28, 4142, Münchenstein

    Prof. Dr. med. Anke Eckardt

  4. Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck MZA, Anichstraße 35, 6020, Innsbruck

    Univ.-Prof. Dr. med. Kai-Michael Scheufler

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  1. Priv.-Doz. Dr. med. Bertram Böhm
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  2. Dr. med. Andreas Lange
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  3. Prof. Dr. med. Anke Eckardt
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  4. Univ.-Prof. Dr. med. Kai-Michael Scheufler
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Böhm, B., Lange, A., Eckardt, A., Scheufler, KM. (2011). Therapeutische Möglichkeiten – interventionelle und operative Verfahren. In: Praxis LWS-Erkrankungen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-88507-8_5

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