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Aktuelle Rheumatologie 2015; 40(05): 388-397
DOI: 10.1055/s-0035-1548864
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Operative Versorgung der Halswirbelsäule. Technische Optionen und Indikationen in Abhängigkeit der jeweiligen Krankheitsbilder

Surgery of the Cervical Spine. Technical Options and Indications for Various Clinical Entities
J. A. Richolt
1   Agaplesion FDK, Sektion Wirbelsäulenchirurgie, Frankfurt
,
C. Barth
2   Agaplesion Bethanien FDK, Chirurgie, Frankfurt
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
28. April 2015 (online)

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Zusammenfassung

Hintergrund: Viele Erkrankungen und Verletzungen an der Halswirbelsäule (HWS) bedürfen der chirurgischen Behandlung. Diese kann sich eines breiten Repertoires verschiedener Verfahren bedienen. Welche Kombination der einzelnen Verfahren sinnvoll ist, hängt von der jeweiligen Art der Erkrankung und der Lokalisation ab. Der Artikel gibt eine Übersicht über die chirurgischen Optionen und deren Anwendung bei den Erkrankungen der HWS.

Methoden (Erkrankungen und chirurgische ­Methoden): Die HWS kann Schäden durch Verletzungen, akute und chronische Entzündungen, Tumore und Degenerationen erleiden. Jede dieser Entitäten kann kurz- oder langfristig in Abhängigkeit von Umfang und Verlauf zu Instabilitäten oder auch symptomatischen Einengungen der Spinalkanales oder der Neuroforaminae führen. In diesen Fällen sind dann konservative Methoden meist nicht ausreichend. Die Chirurgie der HWS bietet zur Behandlung derartiger Probleme einerseits stabilisierende, andererseits dekomprimierende Verfahren an. Diese Methoden sind jeweils über Zugänge von ventral und/oder dorsal umsetzbar. Während die ventralen Zugänge sich entlang anatomischer Verschiebeschichten wie Faszien orientieren und damit weniger traumatisch sind, muss bei dorsalen offenen Verfahren die Nackenmuskulatur von den hinteren Abschnitten der Wirbel abgelöst werden. Für die technische Stabilisierung der Wirbel stehen im Wesentlichen ventrale Platten und Schrauben, dorsale Schrauben-Stab-Systeme, intervertebrale Cages und Wirbelkörperersatz-Implantate zur Verfügung. Eine dauerhafte Stabilisierung über die technische Stabilisierung hinaus bedarf bspw. einer Apposition von Knochen, um eine biologische und damit dauerhafte Fusion zu erreichen.

Ergebnisse: Anhand von 3 Fällen werden verschiedene chirurgische Optionen in Abhängigkeit der Erkrankungen und deren Lokalisationen und Ausdehnungen abgebildet. Dargestellt wird eine ausgedehnte spinale Enge auf der Basis degenerativer Veränderungen, eine Diszitits mit epiduralem Abzeß und ein Fall mit kyphotischer Fehlstellung bei pathologischen Frakturen über 4 konsekutive Wirbel.

Schlussfolgerung: Ebenso mannigfaltig wie die Erkrankungen der HWS sind die chirurgischen Optionen und deren Kombinationsmöglichkeiten. Das Wissen um die Möglichkeiten und die Erfahrung um deren Umsetzung ist notwendig um in Kooperation mit weiteren Fachrichtungen die korrekten Indikationen zu finden.

Abstract

Background: Many diseases and injuries of the cervical spine (CS) require surgical treatment. A wide pepertoire of different processes is available for such cases. The choice of combination of individual methods depends on the nature of the problem and its localisation. The present article provides a survey of the surgical options and their use in diseases of the CS.

Methods (Diseases and Surgical Methods): The CS can suffer damage through injury, acute and chronic inflammatory processes, tumours and degneration. Each of these entities can lead in the short- or long-term to instability or also symptomatic impingement of the spinal canal or neuroforamins depending on the extent and course. Surgery of the CS provides on the one hand stabilising and on the other hand decompressing procedures for the management of these problems. Each of these methods can be applied via a ventral and/or a dorsal approach. While the ventral approaches are oriented along anatomic layers such as the fascia and are thus less traumatic, in open dorsal procedures the neck musculature must be detached from the posterior sections of the spinal bodies. Ventral plates and screws, dorsal screw-rod systems, intervertebral cages and replacement grafts are mainly availble for use in technical stabilisation of the spine. A permanent stabilisation beyond such a technical stabilisation requires, for example, an apposition of bones in order to realise a pewrmanent fusion.

Ergebnisse: On the basis of 3 cases the various surgical options in dependence on the disease, its localistaion and extent are illustrated. We describe an extensive spinal constriction due to degenerative changes, a discitis with epidural abscess and a case with kyphotic misalignment with pathological fractures over 4 consecutive spinal bodies.

Conclusions: The surgical options and their possible combinations are just as manifold as the diseases of the CS. Knowledge of the possibilities and experience in their application as well as cooperation with other specialties are essential in order to derive the correct indication.

Schlüsselwörter

Halswirbelsäule - Operationen - Erkrankungen

Key words

cervical spine - surgery - diseases
 

  • Literatur

  • 1 Elsberg C. Tumors of the Spinal Cord and the Symptoms of Irritation and Compression of the Spinal Cord and Nerve Roots: Pathology, Symptomatology, Diagnosis and Treatment. New York, NY: Paul B. Hoeber; 1925
    Google Scholar
  • 2 Schmorl G. Über die pathologische Anatomie der Wirbelbandscheiben. Beitr Klin Chir 1931; 151: 360-368
    PubMedGoogle Scholar
  • 3 Semmes R, Murphey F. The Syndrom of unilateral rupture of the sixth cervical intervetrebral disk with compression of the seventh cervical nerve root. A report of four cases with symptoms simulating coronary disease. JAMA 1943; 121: 1209-1214 DOI: 101001/jama194302840150023006.
    CrossrefPubMedGoogle Scholar
  • 4 Spurling R, Segerberg L. Lateral intervertebral disc lesions in the lower cervical region. JAMA 1953; 151: 354-359
    PubMedGoogle Scholar
  • 5 Brain R, Wilkinson M. The association of cervical spondylosis and disseminated sclerosis. Brain. Not Available 1957; 80: 456-478
    PubMedGoogle Scholar
  • 6 Frykholm R. Lower cervical vertebrae and intervertebral discs; surgical anatomy and pathology. Acta Chir Scand. (Not Available) 1951; 101: 345-359
    PubMedGoogle Scholar
  • 7 Robinson R, Smith G. Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bulletin of John Hopkins Hospital 1955; 96: 223-224
    PubMedGoogle Scholar
  • 8 Cloward R. The Anterior Approach for Removal of Ruptured Cervical Disks. J Neurosurg 1958; 15: 602-617
    CrossrefPubMedGoogle Scholar
  • 9 Hirsch C. Cervical disc rupture: diagnosis and therapy. Acta Orthop Scand 1960; 30: 172-186
    PubMedGoogle Scholar
  • 10 Grote W, Röttgen P. Die ventrale Fusion bei der zervikalen Osteochondrose und ihre Behandlungsergebnisse. Acta Neurochir 1967; 16: 218-240
    CrossrefPubMedGoogle Scholar
  • 11 Kaden B, Swamy S, Schmitz H. Titanium implant as an alternative possibility in fusion of the cervical vertebrae – initial clinical experiences. 1993; Zentralbl Neurochir 54: 166-170
    PubMedGoogle Scholar
  • 12 Lee MJ, Bazaz R, Furey CG et al. Risk factors for dysphagia after anterior cervical spine surgery: a two-year prospective cohort study. Spine J [Internet]. United States 2007; 7: 141-147
    PubMedGoogle Scholar
  • 13 Guyer RD, Ohnmeiss DD. Intervertebral disc prostheses. Spine (Phila Pa 1976). United States 2003; 28: S15-S23
    PubMedGoogle Scholar
  • 14 Uschold TD, Fusco D, Germain R et al. Cervical and lumbar spinal arthroplasty: clinical review. AJNR Am J Neuroradiol. United States 2012; 33: 1631-1641
    PubMedGoogle Scholar
  • 15 Harrod CC, Hilibrand AS, Fischer DJ. Adjacent segment pathology following cervical motion-sparing procedures or devices compared with fusion surgery: a systematic review. Spine (Phila Pa 1976). United States 2012; 37: S96-S112
    PubMedGoogle Scholar
  • 16 Lee JC, Lee S-H, Peters C et al. Risk-factor analysis of adjacent-segment pathology requiring surgery following anterior, posterior, fusion, and nonfusion cervical spine operations: survivorship analysis of 1358 patients. J Bone Joint Surg Am. United States 2014; 96: 1761-1767
    PubMedGoogle Scholar
  • 17 Rozankovic M, Marasanov SM, Vukic M. Cervical Disc Replacement With Discover Versus Fusion In A Single Level Cervical Disc Disease: A Prospective Single Center Randomized Trial With A Minimum Two-Year Follow–Up. J Spinal Disord Tech. 2014; in press
    PubMedGoogle Scholar
  • 18 Caruso R, Pesce A, Marrocco L et al. Anterior approach to the cervical spine for treatment of spondylosis or disc herniation: Long-term results. Comparison between ACD, ACDF, TDR. Clin Ter. Italy 2014; 165: e263-e270
    PubMedGoogle Scholar
  • 19 Xie J, Hurlbert RJ. Discectomy versus discectomy with fusion versus discectomy with fusion and instrumentation: a prospective randomized study. Neurosurgery. United States 2007; 61: 107
    PubMedGoogle Scholar
  • 20 Botelho RV, Dos Santos Buscariolli Y. de Barros Vasconcelos Fernandes Serra et al. The choice of the best surgery after single level anterior cervical spine discectomy: a systematic review. Open Orthop J. Netherlands 2012; 6: 121-128
    PubMedGoogle Scholar
  • 21 Fraser JF, Hartl R. Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine. United States 2007; 6: 298-303
    PubMedGoogle Scholar
  • 22 Nandoe Tewarie RDS, RHMA Bartels, Peul WC. Long-term outcome after anterior cervical discectomy without fusion. Eur spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. Germany 2007; 16: 1411-1416
    PubMedGoogle Scholar
  • 23 Dowd GC, Wirth FP. Anterior cervical discectomy: is fusion necessary?. J Neurosurg, United States 1999; 90: 8-12
    PubMedGoogle Scholar
  • 24 Jacobs W, Anderson PG, Limbeek J et al. Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane database Syst Rev England 2004; CD004958
    PubMedGoogle Scholar
  • 25 Jacobs W, Willems PC, van Limbeek J et al. Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane database Syst Rev England 2011; CD004958
    PubMedGoogle Scholar
  • 26 Hacker RJ. A randomized prospective study of an anterior cervical interbody fusion device with a minimum of 2 years of follow-up results. J Neurosurg. United States 2000; 93: 222-226
    PubMedGoogle Scholar
  • 27 Cabraja M, Oezdemir S, Koeppen D et al. Anterior cervical discectomy and fusion: comparison of titanium and polyetheretherketone cages. BMC Musculoskelet Disord England 2012; 13: 172
    PubMedGoogle Scholar
  • 28 Ludolph A.. S1-Leitlinie für Diagnostik und Therapie in der Neurologie: Zervikale spondylotische Myelopathie. 2012
    PubMedGoogle Scholar
  • 29 Chung J-Y, Kim S-K, Jung S-T et al. Clinical adjacent-segment pathology after anterior cervical discectomy and fusion: results after a minimum of 10-year follow-up. Spine J United States 2014; 14: 2290-2298
    PubMedGoogle Scholar
  • 30 Litrico S, Lonjon N, Riouallon G et al. Adjacent segment disease after anterior cervical interbody fusion. A multicenter retrospective study of 288 patients with long-term follow-up. Orthop Traumatol Surg Res France 2014; 100: S305-S309
    PubMedGoogle Scholar
  • 31 Ulmar B.. Wirbelkörperersatz durch expandierbare Titan-Cages. Z Orthop 2004; 142: 449-455
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 32 McLaughlin M. Atlas of Cervical Spine Surgery. 1. Aufl Philadelphia: Elsevier; 2005
    Google Scholar
  • 33 Meyer F, Börm W, Thomé C. Degenerative Cervical Spinal Stenosis: Current Strategies in Diagnosis and Treatment. Deutsches Ärzteblatt International 2008; 105: 366-372
    PubMedGoogle Scholar
  • 34 Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine (Phila Pa 1976). United States 2001; 26: 1511-1515
    PubMedGoogle Scholar
  • 35 Kasperk C., Hillmeier J, Nöldge G. Kyphoplastie – Konzept zur Behandlung schmerzhafter Wirbelkörperbrüche. Dtsch Arztebl 2003; 25
    PubMedGoogle Scholar
  • 36 Vogl TJ, Reith W, Rummeny EJ. Diagnostische und interventionelle Radiologie. 1. Aufl. Berlin-Heidelberg: Springer; 2010
    Google Scholar
  • 37 Clark JG, Abdullah KG, Steinmetz MP et al. Minimally Invasive versus Open Cervical Foraminotomy: A Systematic Review. Glob spine J Germany 2011; 1: 9-14
    PubMedGoogle Scholar
  • 38 Yue WM, Tan CT, Tan SB et al. Results of cervical laminoplasty and a comparison between single and double trap-door techniques. J Spinal Disord United States 2000; 13: 329-335
    PubMedGoogle Scholar
  • 39 Wang X-Y, Dai L-Y, Xu H-Z et al. Prediction of spinal canal expansion following cervical laminoplasty: a computer-simulated comparison between single and double-door techniques. Spine (Phila Pa 1976). United States 2006; 31: 2863-2870
    PubMedGoogle Scholar
  • 40 Nassr A, Eck JC, Ponnappan RK et al. The incidence of C5 palsy after multilevel cervical decompression procedures: a review of 750 consecutive cases. Spine (Phila Pa 1976). United States 2012; 37: 174-178
    PubMedGoogle Scholar
  • 41 Sakaura H, Hosono N, Mukai Y et al. C5 palsy after decompression surgery for cervical myelopathy: review of the literature. Spine (Phila Pa 1976). United States 2003; 28: 2447-2451
    PubMedGoogle Scholar
  • 42 Richter M, Wilke HJ, Kluger P et al. Biomechanical evaluation of a new modular rod-screw implant system for posterior instrumentation of the occipito-cervical spine: in-vitro comparison with two established implant systems. Eur Spine J Germany 2000; 9: 417-425
    PubMedGoogle Scholar
  • 43 Kast E, Mohr K, Richter H et al. Complications of transpedicular screw fixation in the cervical spine. Eur Spine J. Germany 2006; 15: 327-334
    PubMedGoogle Scholar
  • 44 Weigel B, Nerlich M. Praxisbuch Unfallchirurgie. 2 Aufl. Berlin-Heidelberg: Springer; 2011
    CrossrefGoogle Scholar
  • 45 Börm W. Spinale Neurochirurgie. 1. Aufl Stuttgart: Schattauer; 2009
    Google Scholar
  • 46 Kandziora F, Schnake K, Hoffmann R. Surgical procedures to stabilize the upper cervical spine. Unfallchirurg. Germany 2010; 113: 845-858 quiz
    PubMedGoogle Scholar
  • 47 Kim SK, Shin JJ, Kim TH et al. Clinical outcomes of halo-vest immobilization and surgical fusion of odontoid fractures. J Korean Neurosurg Soc Korea (South) 2011; 50: 17-22
    PubMedGoogle Scholar
  • 48 Stannard J, Schmidt A, Kregor P. Spezielle Unfallchirurgie. 1. Aufl. Stuttgart: Thieme; 2008
    Google Scholar
  • 49 France JC, Powell 2nd EN, Emery SE et al. Early morbidity and mortality associated with elderly odontoid fractures. Orthopedics 2012; 35: e889-e894
    CrossrefPubMedGoogle Scholar
  • 50 Vieweg U. Operative Versorgung degenerativer Halswirbelsäulenerkrankungen. Deutsche Gesellschaft für Neurochirurgie. [Internet]. 2014 Available from: http://www.dgnc.de/htm/08/nav/index08_9.html
    PubMedGoogle Scholar
  • 51 Kim CH, Chung CK, Jahng T-A et al. Resumption of ambulatory status after surgery for nonambulatory patients with epidural spinal metastasis. Spine J United States 2011; 11: 1015-1023
    PubMedGoogle Scholar