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DOI: 10.1055/a-1159-8195
Posteriore Dekompressionstechniken an der Halswirbelsäule bei spondylogener zervikaler Myelopathie
Posterior surgical techniques of cervical spondylotic myelopathy![](https://www.thieme-connect.de/media/10.1055-s-00033104/202004/lookinside/thumbnails/11598195_10-1055-a-1159-8195-1.jpg)
Zusammenfassung
Die Dekompression des cervicalen Rückenmarks ist über einen ventralen oder dorsalen Zugangsweg möglich. Bei cervicaler Myelopathie, der häufigsten Ursache für eine Funktionsstörung des Rückenmarks, bieten sich insbesondere für Multilevelstenosen dorsale Verfahren an. Die Laminektomie mit Fusion stellt das Standardverfahren zur posterioren Dekompression dar, während die alleinige Laminektomie in deutschsprachigen Ländern weitgehend verlassen wurde. Die Indikationsstellung zum dorsalen, ventralen oder kombinierten Zugang wird beispielhaft anhand eines Algorithmus beschrieben. In diesem Artikel werden insbesondere die Operations-Techniken der Laminektomie mit dorsaler Spondylodese und der Laminoplastie beschrieben. Beide Verfahren haben Vor- und Nachteile sowie ein spezifisches Risikoprofil, insbesondere bez. postoperativer Nackenschmerzsymptomatik, C5-Parese und Infektionsneigung. Die Indikation zur Laminoplastie sollte nur bei beweglicher HWS und natürlicher Lordose gestellt werden, das Standardverfahren der Laminektomie mit Fusion kennt diese Einschränkung nicht.
Dorsale Dekompressionsverfahren an der Halswirbelsäule können bei richtiger Indikationsstellung mit einem niedrigen Risikoprofil sicher angewandt werden.
Abstract
Cervical myelopathy is the most common disease to lead to neural disfunction of the cervical myelon. To decompress the cervical spinal cord, there are two possibilities: the anterior and the posterior approach. Our intention is to describe the most common techniques of posterior decompression. The decision making to indicate an anterior, posterior or combined approach is described on an exemplary algorithm. We delineate the posterior decompression techniques laminectomy with fusion and laminoplasty. The laminectomy alone lost its indication in our experience.
Both techniques are described with special risk profiles such as postoperative neck pain, C-5-palsy and infection. Laminoplasty in cervical spondylotic myelopathy should be restricted to cases with physiological lordosis and good sagittal mobility of the spine. Other cases should be treated with the standard procedure of laminectomy and fusion.
Dorsal decompression techniques with the right indication can be used safely with low risk.
Publication History
Article published online:
29 October 2020
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Literatur
- 1 Nouri A, Tetreault L, Singh A. et al. Degenerative Cervical Myelopathy: Epidemiology, Genetics, and Pathogenesis. Spine 2015; 40: E675-693
- 2 Papavero L, Schmeiser G, Kothe R. et al. Degenerative Cervical Myelopathy: A Seven-Letter Coding System That Supports Decision Making for the Surgical Approach. Neurospine 2020; 17: 164-171
- 3 Taniyama T, Hirai T, Yamada T. et al. Modified K-line in magnetic resonance imaging predicts insufficient decompression of cervical laminoplasty. Spine 2013; 38: 496-501
- 4 Riley LH, Vaccaro AR, Dettori JR. et al. Postoperative dysphagia in anterior cervical spine surgery. Spine 2010; 35: S76-S85
- 5 Jain A, Rustagi T, Prasad G. et al. Does Segmental Kyphosis Affect Surgical Outcome after a Posterior Decompressive Laminectomy in Multisegmental Cervical Spondylotic Myelopathy?. Asian Spine J 2017; 11: 24-30
- 6 Kaptain GJ, Simmons NE, Replogle RE. et al. Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy. J Neurosurg 2000; 93: 199-204
- 7 Kim P, Murata H, Kurokawa R. et al. Myoarchitectonic spinolaminoplasty: efficacy in reconstituting the cervical musculature and preserving biomechanical function. J Neurosurg Spine 2007; 7: 293-304
- 8 Shiraishi T. Skip laminectomy--a new treatment for cervical spondylotic myelopathy, preserving bilateral muscular attachments to the spinous processes: a preliminary report. Spine J Off J North Am Spine Soc 2002; 2: 108-115
- 9 Stephens BF, Rhee JM, Neustein TM. et al. Laminoplasty Does not Lead to Worsening Axial Neck Pain in the Properly Selected Patient With Cervical Myelopathy: A Comparison With Laminectomy and Fusion. Spine 2017; 42: 1844-1850
- 10 Jin S-W, Kim S-H, Kim B-J. et al. Modified Open-door Laminoplasty Using Hydroxyapatite Spacers and Miniplates. Korean J Spine 2014; 11: 188-194
- 11 Roselli R, Pompucci A, Formica F. et al. Open-door laminoplasty for cervical stenotic myelopathy: surgical technique and neurophysiological monitoring. J Neurosurg 2000; 92 (Suppl. 01) 38-43
- 12 Schmeiser G, Schilling C, Grupp TM. et al. Unilateral laminoplasty with lateral mass screw fixation for less invasive decompression of the cervical spine: a biomechanical investigation. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 2015; 24: 2781-2787
- 13 Youssef JA, Heiner AD, Montgomery JR. et al. Outcomes of posterior cervical fusion and decompression: a systematic review and meta-analysis. Spine J Off J North Am Spine Soc 2019; 19: 1714-1729
- 14 Rampersaud YR, Moro ERP, Neary MA. et al. Intraoperative adverse events and related postoperative complications in spine surgery: implications for enhancing patient safety founded on evidence-based protocols. Spine 2006; 31: 1503-1510
- 15 Yonenobu K, Hosono N, Iwasaki M. et al. Laminoplasty versus subtotal corpectomy. A comparative study of results in multisegmental cervical spondylotic myelopathy. Spine 1992; 17: 1281-1284
- 16 Edwards CC, Heller JG, Murakami H. Corpectomy versus laminoplasty for multilevel cervical myelopathy: an independent matched-cohort analysis. Spine 2002; 27: 1168-1175
- 17 Hojo Y, Ito M, Abumi K. et al. A late neurological complication following posterior correction surgery of severe cervical kyphosis. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 2011; 20: 890-898
- 18 Katonis P, Papadakis SA, Galanakos S. et al. Lateral mass screw complications: analysis of 1662 screws. J Spinal Disord Tech 2011; 24: 415-420
- 19 Mochida J, Nomura T, Chiba M. et al. Modified expansive open-door laminoplasty in cervical myelopathy. J Spinal Disord 1999; 12: 386-391
- 20 Syre P, Bohman L-E, Baltuch G. et al. Cerebrospinal fluid leaks and their management after anterior cervical discectomy and fusion: a report of 13 cases and a review of the literature. Spine 2014; 39: E936-E943
- 21 Sebastian A, Huddleston P, Kakar S. et al. Risk factors for surgical site infection after posterior cervical spine surgery: an analysis of 5,441 patients from the ACS NSQIP 2005-2012. Spine J Off J North Am Spine Soc 2016; 16: 504-509