Orthopädie und Unfallchirurgie up2date 2011; 6(2): 119-142
DOI: 10.1055/s-0030-1256337
Wirbelsäule

© Georg Thieme Verlag KG Stuttgart · New York

Subaxiale degenerative Instabilität und spondylotische Myelopathie

Teil 2O.  Meier1 , J.  Zenner1 , L.  Ferraris1 , A.  Hempfing1 , H.  Koller1
  • 1Werner-Wicker-Klinik, Orthopädisches Schwerpunktklinikum, Bad Wildungen-Reinhardshausen
Further Information

Publication History

Publication Date:
11 April 2011 (online)

Therapeutisch stehen konservative und operative Therapiemöglichkeiten zur Verfügung; abhängig von den vorliegenden Beschwerden sollte bei fehlendem neurologischem Defizit eine mindestens 3-monatige konservative Therapie vor einer operativen Maßnahme durchgeführt werden.

In der operativen Behandlung stehen 2 Verfahrensgruppen zur Verfügung: Die ventrale zervikale Dekompression mit Diskektomie und ggf. Korporektomie sowie dorsale Verfahren, hier insbesondere zu erwähnen die zervikale Laminoplastie. Bei ventralen Verfahren werden die stenosierenden Strukturen reseziert und das Myelon entlastet, Kyphosen werden korrigiert und das Ergebnis durch eine Plattenosteosynthese gesichert. Dorsale Verfahren entlasten das Rückenmark, indem stenosierende Prozesse entfernt werden und der Spinalkanal nach dorsal eröffnet wird, sodass sich das Rückenmark von ventralen Stenosierungen abheben kann; dieses Verfahren ohne Instrumentierung kann nur angewendet werden, wenn keine zervikale Kyphose besteht. Dorsale Laminoplastieverfahren bieten die Möglichkeit, gelenkerhaltend vorzugehen, allerdings mit der Gefahr einer Instabilität und Kyphosierung, sodass eine genaue präoperative Evaluierung unabdingbar ist.

Entscheidend für das Gesamtergebnis bleibt die sorgfältige Indikationsstellung und Patientenselektion sowie eine gründliche Dekompression mit solider Rekonstruktion.

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Dr. O. Meier

Werner-Wicker-Klinik
Orthopädisches Schwerpunktklinikum
Werner Wicker KG

Im Kreuzfeld 4
34537 Bad Wildungen-Reinhardshausen

Phone: 05621/803–0

Fax: 05621/803–208

Email: mitrenga@werner-wicker-klinik.de