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Ventrale Fusion bei Halswirbelsäulenverletzungen

Gegenwärtige Möglichkeiten unter Beachtung der Rekonstruktion des sagittalen Profils

Anterior fusion of cervical spine injuries

Current options under consideration of reconstruction of the sagittal profile

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Die ventrale Fusion stellt bei instabilen Halswirbelsäulenverletzungen den Goldstandard dar, da sich über den atraumatischen ventralen Zugang der Großteil der Halswirbelsäulen (HWS)-Verletzungen versorgen lässt und sich zusätzlich ein hohes Potenzial der Kyphosekorrektur bietet. Hierbei ist die Fusionsstrecke so kurz wie möglich zu wählen, um die postoperative Bewegungseinschränkung mit daraus resultierenden Anschlussdegenerationen zu minimieren. In den letzten Jahren ist ein klarer Trend hin zur Fusion mit Cages in Kombination mit Knochenersatzstoffen zu erkennen, da die Verwendung der autologen Knochenspäne mit einer nicht zu vernachlässigenden Entnahmemorbidität einhergeht. Eine additive ventrale Plattenosteosynthese wird bei traumatischen Instabilitäten stets gefordert. Die Wiederherstellung des sagittalen Profils ist neben der Erzielung einer ventralen Spondylodese ein entscheidender Faktor für den Therapieerfolg, da eine relevante Kyphose das Langzeitergebnis negativ beeinflusst.

Abstract

Anterior fusion is the gold standard procedure for unstable traumatic spinal injuries because most injuries can be managed with this atraumatic approach, which also allows good correction of kyphosis. To prevent functional deficits and degeneration of the adjacent segments, the length of fusion should be as short as possible. In recent years, a trend towards anterior fusion with cages in combination with bone substitutes can be recognized. In contrast, fusion performed with a tricortical iliac bone graft is performed less frequently because relevant donor site morbidity has to be taken into account. Additional anterior plate fixation is mandatory in cases of anterior stabilization for traumatic instability of the cervical spine. Besides anterior fusion, restoration of the sagittal profile seems to be important for the outcome following traumatic cervical spine injuries. This is due to the fact that persisting cervical kyphosis has a negative impact on the long-term results after cervical spine stabilization.

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Authors and Affiliations

  1. Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinik Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    M. Pishnamaz, C. Herren, H.-C. Pape &  P. Kobbe

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  1. M. Pishnamaz
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  2. C. Herren
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  3. H.-C. Pape
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  4. P. Kobbe
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Correspondence to P. Kobbe.

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M. Pishnamaz, C. Herren, H.-C. Pape und P. Kobbe geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Pishnamaz, M., Herren, C., Pape, HC. et al. Ventrale Fusion bei Halswirbelsäulenverletzungen. Trauma Berufskrankh 18, 268–274 (2016). https://doi.org/10.1007/s10039-016-0211-0

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  • DOI: https://doi.org/10.1007/s10039-016-0211-0

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