Posteriore Dekompressionstechniken an der Halswirbelsäule bei spondylogener zervikaler Myelopathie

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.

Schlüsselwörter

Halswirbelsäule - dorsale Dekompression - Laminektomie - Laminoplastie

Key words

Cervical Spine - posterior decompression - laminectomy - laminoplasty

Publication History

Article published online:
29 October 2020

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