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DOI: 10.1055/a-2167-1287
Enger Spinalkanal und osteoligamentäre Verletzung der Halswirbelsäule – Synthese
Spinal Canal Stenosis and Osteoligamentous Injury of the Cervical Spine – Synthesis![](https://www.thieme-connect.de/media/10.1055-s-00033104/202401/lookinside/thumbnails/10-1055-a-2167-1287-1.jpg)
Zusammenfassung
Patienten mit Spinalkanalstenose und osteoligamentärer Verletzung stellen ein sehr heterogenes Kollektiv dar. Neurologisches Defizit, Ausmaß und Lokalisation der Stenose wie auch des Myelonschadens variieren ebenso wie das Ausmaß und die Lokalisation der osteoligamentären Verletzung. Einheitliche Therapierichtlinien, insbesondere zur Operationsindikation, liegen daher nicht vor. Einigkeit besteht darin, dass instabile Wirbelsäulenverletzungen in stabile operativ überführt werden. Bei Vorliegen einer stabilen Verletzung sind patientenspezifische Faktoren für die Wahl der Therapie entscheidend, da die Studienlage nach wie vor kein ausreichendes Evidenzniveau ergibt.
Abstract
Patients with osteoligamentous injuries of the cervical spine with preexisting spinal canal stenosis form a heterogenous group. Neurological deficits, extent and localization of canal stenosis as well as the spinal cord are variable. Uniform standards of therapy, especially with regard to surgical intervention, do not exist. There is unity, that the unstable spine should be surgically converted into a stable one. In stable trauma, patient-specific factors are paramount for the decision, which therapy should be used, as the present studies do not reach a satisfactory level of evidence.
Schlüsselwörter
zervikale Spinalkanalstenose - Rückenmarksverletzung - neurologisches Defizit - osteoligamentäre Verletzung - EvidenzKeywords
cervical stenosis - spinal cord injury - neurological deficit - osteoligemantous trauma - evidencePublikationsverlauf
Artikel online veröffentlicht:
07. Februar 2024
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Literatur
- 1 Schleicher P, Scholz M, Kandziora F. et al. Therapieempfehlungen zur Versorgung von Verletzungen der subaxialen Halswirbelsäule [Subaxial Cervical Spine Injuries: Treatment Recommendations of the German Orthopedic and Trauma Society]. Z Orthop Unfall 2017; 155: 556-566 DOI: 10.1055/s-0043-110855.
- 2 Barz M, Janssen IK, Aftahy K. et al. Incidence of discoligamentous injuries in patients with acute central cord syndrome and underlying degenerative cervical spinal stenosis. Brain Spine 2022; 2: 100882 DOI: 10.1016/j.bas.2022.100882.
- 3 Chang V, Ellingson BM, Salamon N. et al. The Risk of Acute Spinal Cord Injury After Minor Trauma in Patients With Preexisting Cervical Stenosis. Neurosurgery 2015; 77: 561-565 DOI: 10.1227/NEU.0000000000000888.
- 4 Aarabi B, Alexander M, Mirvis SE. et al. Predictors of outcome in acute traumatic central cord syndrome due to spinal stenosis. J Neurosurg Spine 2011; 14: 122-130 DOI: 10.3171/2010.9.SPINE09922. (PMID: 21166485)
- 5 Aarabi B, Sansur CA, Ibrahimi DM. et al. Intramedullary Lesion Length on Postoperative Magnetic Resonance Imaging is a Strong Predictor of ASIA Impairment Scale Grade Conversion Following Decompressive Surgery in Cervical Spinal Cord Injury. Neurosurgery 2017; 80: 610-620 DOI: 10.1093/neuros/nyw053.. (PMID: 28362913)
- 6 Kamal R, Verma H, Narasimhaiah S. et al. Predicting the Role of Preoperative Intramedullary Lesion Length and Early Decompressive Surgery in ASIA Impairment Scale Grade Improvement Following Subaxial Traumatic Cervical Spinal Cord Injury. J Neurol Surg A Cent Eur Neurosurg 2023; 84: 144-156 DOI: 10.1055/s-0041-1740379.. (PMID: 35668673)
- 7 Mora-Boga R, Vázquez-Muíños O, Pértega-Díaz S. et al. A. Neurological recovery after traumatic spinal cord injury: prognostic value of magnetic resonance. Spinal Cord 2022; 60: 533-539 DOI: 10.1038/s41393-022-00759-0. (PMID: 35105961)
- 8 Torg JS, Corcoran TA, Thibault LE. et al. Cervical cord neurapraxia: classification, pathomechanics, morbidity, and management guidelines. J Neurosurg 1997; 87: 843-850 DOI: 10.3171/jns.1997.87.6.0843.. (PMID: 9384393)
- 9 Burns SP, Weaver F, Chin A. et al. Cervical stenosis in spinal cord injury and disorders. J Spinal Cord Med 2016; 39: 471-5 DOI: 10.1080/10790268.2015.1114229. (PMID: 26666404)
- 10 Lenehan B, Fisher CG, Vaccaro A. et al. The urgency of surgical decompression in acute central cord injuries with spondylosis and without instability. Spine (Phila Pa 1976) 2010; 35 (Suppl. 21) S180-186 DOI: 10.1097/BRS.0b013e3181f32a44.
- 11 Fehlings MG, Tetreault LA, Wilson JR. et al. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury and Central Cord Syndrome: Recommendations on the Timing (≤24 Hours Versus >24 Hours) of Decompressive Surgery. Global Spine J 2017; 7 (Suppl. 3) 195S-202S DOI: 10.1177/2192568217706367.
- 12 Ronzi Y, Perrouin-Verbe B, Hamel O. et al. Spinal cord injury associated with cervical spinal canal stenosis: Outcomes and prognostic factors. Ann Phys Rehabil Med 2018; 61: 27-32 DOI: 10.1016/j.rehab.2017.09.003.
- 13 Schneider RC, Thompson JM, Bebin J. The syndrome of acute central cervical spinal cord injury. J Neurol Neurosurg Psychiatry 1958; 21: 216-227 DOI: 10.1136/jnnp.21.3.216. (PMID: 13576174)
- 14 Lamothe G, Muller F, Vital JM. et al. Evolution of spinal cord injuries due to cervical canal stenosis without radiographic evidence of trauma (SCIWORET): a prospective study. Ann Phys Rehabil Med 2011; 54: 213-224 DOI: 10.1016/j.rehab.2011.02.003.
- 15 Chen L, Yang H, Yang T. et al. Effectiveness of surgical treatment for traumatic central cord syndrome. J Neurosurg Spine 2009; 10: 3-8 DOI: 10.3171/2008.9.SPI0822. (PMID: 19119925)
- 16 Kumar AA, Wong JYH, Pillay R. et al. Treatment of acute traumatic central cord syndrome: a score-based approach based on the literature. Eur Spine J 2023; 32: 1575-1583 DOI: 10.1007/s00586-023-07626-3. (PMID: 36912986)
- 17 Kawano O, Ueta T, Shiba K. et al. Outcome of decompression surgery for cervical spinal cord injury without bone and disc injury in patients with spinal cord compression: a multicenter prospective study. Spinal Cord 2010; 48: 548-553 DOI: 10.1038/sc.2009.179.
- 18 Badhiwala JH, Wilson JR, Harrop JS. et al. Early vs Late Surgical Decompression for Central Cord Syndrome. JAMA Surg 2022; 157: 1024-1032 DOI: 10.1001/jamasurg.2022.4454. (PMID: 36169962)
- 19 Chikuda H, Koyama Y, Matsubayashi Y. OSCIS investigators. et al. Effect of Early vs Delayed Surgical Treatment on Motor Recovery in Incomplete Cervical Spinal Cord Injury With Preexisting Cervical Stenosis: A Randomized Clinical Trial. JAMA Netw Open 2021; 4: e2133604 DOI: 10.1001/jamanetworkopen.2021.33604.. (PMID: 34751757)
- 20 Lee S, Kim C, Ha JK. et al. Comparison of Early Surgical Treatment With Conservative Treatment of Incomplete Cervical Spinal Cord Injury Without Major Fracture or Dislocation in Patients With Pre-existing Cervical Spinal Stenosis. Clin Spine Surg 2021; 34: E141-E146 DOI: 10.1097/BSD.0000000000001065. (PMID: 32925187)
- 21 El Masri Y WS. Traumatic spinal injury and spinal cord injury: point for active physiological conservative management as compared to surgical management. Spinal Cord Ser Cases 2018; 4: 14 DOI: 10.1038/s41394-018-0045-z. (PMID: 29479483)
- 22 Guttmann L. Spinal cord injuries. Comprehensive management and research. Oxford: Blackwell Science Ltd; 1973
- 23 Frankel HL, Hancock DO, Hyslop G. et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia 1969; 7: 179-192 DOI: 10.1038/sc.1969.30.
- 24 Fawcett JW, Curt A, Steeves JD. et al. Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials. Spinal Cord 2007; 45: 190-205 DOI: 10.1038/sj.sc.3102007. (PMID: 17179973)
- 25 Bartels RH, Hosman AJ, van de Meent H. et al. Design of COSMIC: a randomized, multi-centre controlled trial comparing conservative or early surgical management of incomplete cervical cord syndrome without spinal instability. BMC Musculoskelet Disord 2013; 14: 52 DOI: 10.1186/1471-2474-14-52. (PMID: 23369169)
- 26 Fouad K, Popovich PG, Kopp MA. et al. The neuroanatomical-functional paradox in spinal cord injury. Nat Rev Neurol 2021; 17: 53-62 DOI: 10.1038/s41582-020-00436-x.
- 27 Yue JK, Hemmerle DD, Winkler EA. et al. Clinical Implementation of Novel Spinal Cord Perfusion Pressure Protocol in Acute Traumatic Spinal Cord Injury at U.S. Level I Trauma Center: TRACK-SCI Study. World Neurosurg 2020; 133: e391-e396 DOI: 10.1016/j.wneu.2019.09.044. (PMID: 31526882)
- 28 Yelamarthy PKK, Chhabra HS, Vaccaro A. et al. Management and prognosis of acute traumatic cervical central cord syndrome: systematic review and Spinal Cord Society-Spine Trauma Study Group position statement. Eur Spine J 2019; 28: 2390-2407 DOI: 10.1007/s00586-019-06085-z. (PMID: 31367852)