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Perioperatives Management nach traumatischer Querschnittslähmung

Komplikationen vermeiden

Perioperative management after traumatic paraplegia

Avoiding complications

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Zusammenfassung

Dieser Beitrag beschreibt den aktuellen Stand der Behandlung traumatischer Rückenmarkverletzungen mit dem Fokus auf die perioperative Phase. Es werden epidemiologische und ökonomische Auswirkungen der Verletzungen erläutert sowie altersbedingte Spezifika berücksichtigt, die sich auf eine erfolgreiche Behandlung auswirken können. Betont wird die Bedeutung einer schnellen, interdisziplinären Behandlung unter Einhaltung des „Time-is-spine“-Prinzips. Moderne diagnostische und operative Techniken, die eine individuelle Behandlung unter Berücksichtigung von Begleitverletzungen und Erkrankungen ermöglichen, werden vorgestellt. Präventions- und Behandlungsmöglichkeiten häufiger Komplikationen werden präsentiert. Zusammenfassend kann eine erfolgreiche langfristige Behandlung von traumatischen Rückenmarkverletzungen durch eine rechtzeitige, interdisziplinäre Behandlung mit modernen Techniken unter Berücksichtigung individueller Besonderheiten erreicht werden.

Abstract

This article describes the current status of modern treatment options for traumatic spinal cord injuries with a particular focus on the perioperative phase. Along with a recognition of age-related specific features that can impact successful treatment of spinal injuries, prompt interdisciplinary treatment while adhering to the “time is spine” principle is of high importance. By considering this approach and using modern diagnostic and surgical techniques, successful surgical treatment can be achieved while taking into account individual characteristics, such as reduced bone quality, accompanying injuries as well as oncological and inflammatory rheumatic comorbidities. The preventive and treatment strategies for frequently occurring complications in the management of traumatic spinal cord injuries are presented. By considering case-specific factors, utilizing modern surgical techniques, avoiding or promptly treating typical complications and initiating interdisciplinary treatment, crucial groundwork for a successful long-term treatment of this highly debilitating and life-altering injury can be established in the perioperative phase.

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Literatur

  1. Hughes JT (1988) The Edwin Smith surgical papyrus: an analysis of the first case reports of spinal cord injuries. Spinal Cord 26(2):71–82

    Article  CAS  Google Scholar 

  2. Rau Y, Schulz A‑P, Thietje R, Matrisch L, Frese J, Hirschfeld S (2023) Incidence of spinal cord injuries in Germany. Eur Spine J 32(2):601–607

    Article  PubMed  Google Scholar 

  3. Ozpinar A, Perez JL, Hacker E, Alan N, Agarwal N, Deng H et al (2022) Operative outcomes after cervical diffuse idiopathic skeletal hyperostosis fracture in the elderly. Int J Spine Surg 16(3):435–441

    Article  PubMed  PubMed Central  Google Scholar 

  4. Pedro KM, Fehlings MG (2022) Time is spine: what’s over the horizon. J Clin Orthop Trauma 35:102043

    Article  PubMed  Google Scholar 

  5. Jin Y, Song Y, Lin J, Liu T, Li G, Lai B et al (2023) Role of inflammation in neurological damage and regeneration following spinal cord injury and its therapeutic implications. Burns Trauma 11:tkac54

    Article  PubMed  PubMed Central  Google Scholar 

  6. Dumont RJ, Okonkwo DO, Verma S, Hurlbert RJ, Boulos PT, Ellegala DB et al (2001) Acute spinal cord injury, part I: pathophysiologic mechanisms. Clin Neuropharmacol 24(5):254–264

    Article  CAS  PubMed  Google Scholar 

  7. American College of Surgeons (2018) Advanced trauma life support® (ATLS®) student course manual, 10. Aufl.

    Google Scholar 

  8. Hachem LD, Ahuja CS, Fehlings MG (2017) Assessment and management of acute spinal cord injury: from point of injury to rehabilitation. J Spinal Cord Med 40(6):665–675

    Article  PubMed  PubMed Central  Google Scholar 

  9. Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ et al (2001) The Canadian C‑spine rule for radiography in alert and stable trauma patients. JAMA 286(15):1841–1848

    Article  CAS  PubMed  Google Scholar 

  10. Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI (2000) Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National emergency X‑radiography utilization study group. N Engl J Med 343(2):94–99

    Article  CAS  PubMed  Google Scholar 

  11. Roberts TT, Leonard GR, Cepela DJ (2017) Classifications in brief: American spinal injury association (ASIA) impairment scale. Clin Orthop Relat Res 475(5):1499–1504

    Article  PubMed  Google Scholar 

  12. Eli I, Lerner DP, Ghogawala Z (2021) Acute traumatic spinal cord injury. Neurol Clin 39(2):471–488

    Article  PubMed  Google Scholar 

  13. Ellingson BM, Salamon N, Holly LT (2014) Imaging techniques in spinal cord injury. World Neurosurg 82(6):1351–1358

    Article  PubMed  Google Scholar 

  14. Ahuja CS, Wilson JR, Nori S, Kotter MRN, Druschel C, Curt A et al (2017) Traumatic spinal cord injury. Nat Rev Dis Primers 3:17018

    Article  PubMed  Google Scholar 

  15. Vaccaro AR, Koerner JD, Radcliff KE, Oner FC, Reinhold M, Schnake KJ et al (2016) AOSpine subaxial cervical spine injury classification system. Eur Spine J 25(7):2173–2184

    Article  PubMed  Google Scholar 

  16. Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C et al (2013) AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976) 38(23):2028–2037

    Article  PubMed  Google Scholar 

  17. Fehlings MG, Martin AR, Tetreault LA, Aarabi B, Anderson P, Arnold PM et al (2017) A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the role of baseline magnetic resonance imaging in clinical decision making and outcome prediction. Global Spine J 7(3):221S–230S

    Article  PubMed  PubMed Central  Google Scholar 

  18. Nakashima H, Yukawa Y, Ito K, Machino M, El Zahlawy H, Kato F (2011) Posterior approach for cervical fracture-dislocations with traumatic disc herniation. Eur Spine J 20(3):387–394

    Article  PubMed  Google Scholar 

  19. Vaccaro AR, Falatyn SP, Flanders AE, Balderston RA, Northrup BE, Cotler JM (1999) Magnetic resonance evaluation of the intervertebral disc, spinal ligaments, and spinal cord before and after closed traction reduction of cervical spine dislocations. Spine (Phila Pa 1976) 24(12):1210–1217

    Article  CAS  PubMed  Google Scholar 

  20. Bozzo A, Marcoux J, Radhakrishna M, Pelletier J, Goulet B (2011) The role of magnetic resonance imaging in the management of acute spinal cord injury. J Neurotrauma 28(8):1401–1411

    Article  PubMed  PubMed Central  Google Scholar 

  21. Consortium for Spinal Cord Medicine (2008) Early acute management in adults with spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med 31(4):403–479

    Article  Google Scholar 

  22. Claxton AR, Wong DT, Chung F, Fehlings MG (1998) Predictors of hospital mortality and mechanical ventilation in patients with cervical spinal cord injury. Can J Anaesth 45(2):144–149

    Article  CAS  PubMed  Google Scholar 

  23. Jaber S, Jung B, Matecki S, Petrof BJ (2011) Clinical review: ventilator-induced diaphragmatic dysfunction—human studies confirm animal model findings! Crit Care 15(2):206

    Article  PubMed  PubMed Central  Google Scholar 

  24. Foran SJ, Taran S, Singh JM, Kutsogiannis DJ, McCredie V (2022) Timing of tracheostomy in acute traumatic spinal cord injury: a systematic review and meta-analysis. J Trauma Acute Care Surg 92(1):223–231

    Article  PubMed  Google Scholar 

  25. Gefen A (2008) How much time does it take to get a pressure ulcer? Integrated evidence from human, animal, and in vitro studies. Ostomy Wound Manage 54(10):26–8–30–5

    PubMed  Google Scholar 

  26. Vecin NM, Gater DR (2022) Pressure injuries and management after spinal cord injury. J Pers Med 12(7):1130. https://doi.org/10.3390/jpm12071130

    Article  PubMed  PubMed Central  Google Scholar 

  27. Mourelo Fariña M, Salvador de la Barrera S, Montoto Marqués A, Ferreiro Velasco ME, Galeiras Vázquez R (2017) Update on traumatic acute spinal cord injury. Part 2. Med Intensiva 41(5):306–315

    Article  PubMed  Google Scholar 

  28. Shem K, Castillo K, Wong S, Chang J (2011) Dysphagia in individuals with tetraplegia: incidence and risk factors. J Spinal Cord Med 34(1):85–92

    Article  PubMed  PubMed Central  Google Scholar 

  29. Consortium for Spinal Cord Medicine (2016) Prevention of venous thromboembolism in individuals with spinal cord injury: clinical practice guidelines for health care providers, 3rd ed. Top Spinal Cord Inj Rehabil 22(3):209–240

    Article  Google Scholar 

  30. Aito S, Pieri A, D’Andrea M, Marcelli F, Cominelli E (2002) Primary prevention of deep venous thrombosis and pulmonary embolism in acute spinal cord injured patients. Spinal Cord 40(6):300–303

    Article  CAS  PubMed  Google Scholar 

  31. Welk B, Lenherr S, Elliott S, Stoffel J, Presson AP, Zhang C et al (2018) The neurogenic bladder symptom score (NBSS): a secondary assessment of its validity, reliability among people with a spinal cord injury. Spinal Cord 56(3):259–264

    Article  PubMed  Google Scholar 

  32. Jamison J, Maguire S, McCann J (2013) Catheter policies for management of long term voiding problems in adults with neurogenic bladder disorders. Cochrane Database Syst Rev 11:Cd4375

    Google Scholar 

  33. Brackett NL (2012) Infertility in men with spinal cord injury: research and treatment. Scientifica (Cairo) 2012:578257

    PubMed  Google Scholar 

  34. Wang JZ, Yang M, Meng M, Li ZH (2023) Clinical characteristics and treatment of spinal cord injury in children and adolescents. Chin J Traumatol 26(1):8–13

    Article  PubMed  Google Scholar 

  35. Alexander MS, Anderson KD, Biering-Sorensen F, Blight AR, Brannon R, Bryce TN et al (2009) Outcome measures in spinal cord injury: recent assessments and recommendations for future directions. Spinal Cord 47(8):582–591

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Westerveld LA, Verlaan JJ, Oner FC (2009) Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J 18(2):145–156

    Article  CAS  PubMed  Google Scholar 

  37. Jacobsen S, Sonne-Holm S, Rovsing H, Monrad H, Gebuhr P (2007) Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen osteoarthritis study. Spine (Phila Pa 1976) 32(1):120–125

    Article  PubMed  Google Scholar 

  38. Ward MM, Deodhar A, Akl EA, Lui A, Ermann J, Gensler LS et al (2016) American college of rheumatology/spondylitis association of america/spondyloarthritis research and treatment network 2015 recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Rheumatol 68(2):282–298

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Sektion Wirbelsäulenchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    Annika Heuer, Leon-Gordian Koepke,  Lennart Viezens & Malte Schroeder

Authors
  1. Annika Heuer
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  2. Leon-Gordian Koepke
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  3. Lennart Viezens
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  4. Malte Schroeder
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Corresponding author

Correspondence to Lennart Viezens.

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Interessenkonflikt

L. Viezens ist als Referent für die DePuy Synthes und Medtronic tätig. A. Heuer, L.-G. Koepke und M. Schroeder geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Stephan Sehmisch, Hannover

Die Autor*innen Annika Heuer, Leon-Gordian Koepke und Lennart Viezens haben zu gleichen Teilen zur vorliegenden Arbeit beigetragen und teilen sich die Erstautorenschaft.

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Heuer, A., Koepke, LG., Viezens, L. et al. Perioperatives Management nach traumatischer Querschnittslähmung. Unfallchirurgie 126, 749–755 (2023). https://doi.org/10.1007/s00113-023-01342-9

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  • DOI: https://doi.org/10.1007/s00113-023-01342-9

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