Der zervikale Bandscheibenvorfall – Spontanverlauf, Therapieoptionen und klinische Ergebnisse

Zusammenfassung

Die alters- und belastungsabhängige Degeneration der Halsbandscheibe kann zu einem weichen Halsbandscheibenvorfall führen oder eine Kaskade weiterer Prozesse auslösen, welche in einen harten Bandscheibenvorfall, die zervikale Spondylose, einmünden. Während ein Wurzelreiz- oder Wurzelkompressionssyndrom die vorherrschende Symptomatik beim weichen Bandscheibenvorfall ist, dominiert bei der zervikalen Spondylose die Myelopathie. Bildgebende Verfahren zur Diagnosestellung sind die Magnetresonanztomographie (MRT) und Computertomographie (CT), bei geplanter Operation gegebenenfalls ergänzt durch Röntgenaufnahmen in Neutral-, Flexions- und Extensionsstellung. Bei einem weichen Bandscheibenvorfall besteht eine Operationsindikation bei einem therapieresistenten radikulären Schmerzsyndrom oder einer myotombezogenen Parese. Bei einer zervikalen Spondylose ist spätestens bei Nachweis einer moderaten Myelopathie eine Operation unumgänglich. Es existieren sowohl für den weichen Bandscheibenvorfall als auch für die zervikale Spondylose etablierte anteriore und posteriore Operationsverfahren. Auch wenn es in Deutschland eine deutliche Präferenz für anteriore Verfahren gibt, konnte bislang keine Überlegenheit eines Verfahrens sowohl hinsichtlich Symptomkontrolle als auch hinsichtlich Komplikationsquote gezeigt werden.

Abstract

The age- and motion-related degeneration of the cervical spine may result in a soft disc herniation or can evoke a cascade of further degenerative changes leading to cervical spondylosis. Radiculopathy is the key symptom of a soft disc, whereas myelopathy is typically found in cervical spondylosis (cervical spondylotic myelopathy [CSM]). The diagnosis is established by magnetic resonance imaging (MRI) and computerized tomography (CT). If surgery is considered lateral, flexion and extension radiographs might be helpful for selecting the most suitable operative strategy. Indications for surgery are 1- radicular pain not responsive to adequate conservative therapy and/or a motor deficit in patients with a soft disc herniation, and 2- an at least moderate myelopathy in patients with CSM. Anterior approaches are preferentially used in Germany to treat soft disc herniation and CSM. However, posterior approaches have comparable results in terms of symptom control and complication rate and could not be considered as an inferior therapeutic option.

Schlüsselwörter

Halsbandscheibenvorfall - zervikale Myelopathie - ACDF - ACCF - Bandscheibenprothese - Laminoplastie - Laminektomie

Keywords

cervical degenerative disc disease - cervical spondylotic myelopathy - ACDF - ACCF - arthroplasty - laminoplasty - laminectomy

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