Zusammenfassung
Eine ideale Klassifikation des Wirbelsäulentraumas gibt es bis heute nicht, v. a., da sich die Zusammenführung morphologischer, biomechanischer und klinischer Parameter in eine einzige Einteilung bislang als undurchführbar erwies. In der Zusammenarbeit zwischen Radiologie und den chirurgischen Fächern haben sich nur einzelne Klassifikationen von Verletzungsmustern als sinnvoll herausgestellt, um rasche und sichere Therapieentscheidungen zu treffen. Viele Wertungssysteme sind aufgrund ihrer Komplexität nicht uneingeschränkt praxistauglich, etwa die von der Arbeitsgemeinschaft für Osteosynthesefragen (AO) übernommene Magerl-Klassifikation. Nicht zuletzt deshalb haben in der Traumatologie der Wirbelsäule Eigennamen und Synonyme einen großen Stellenwert, vergleichbar mit jenen der Extremitätenverletzungen. Alle Mitglieder eines Traumateams sollten sich der Definition der verwendeten Begriffe sowie der Stärken und Schwächen der bestehenden Klassifikationen des Wirbelsäulentraumas bewusst sein.
Abstract
The ideal classification of spinal trauma does not yet exist, primarily because the combination of morphological, biomechanical and clinical parameters in one single nomenclature has proved impossible. For radiologists and surgeons who work closely together, only a few classifications of injury patterns have been shown to be useful enough to provide rapid and stable therapy decisions. Many classifications are too complex to be practical for day-to-day practice, such as the Magerl classification, which has been adopted by the Arbeitsgemeinschaft für Osteosynthesefragen (AO). Not least because of this classification difficulty, eponyms and synonyms are widely used to describe trauma of the spine, comparable to the number of terms used to describe fractures of the upper and lower limbs. The members of trauma teams should be aware of the definitions of these terms as well as the strengths and limitations of the existing classifications of spinal trauma.
Literatur
Anderson LD, D’Alonzo RT (1974) Fractures of the odontoid process of the axis. J Bone Joint Surg [Am] 56:1663–1674
Anderson PA, Montesano PX (1988) Morphology and treatment of occipital condyle fractures. Spine 13:731–736
Bogduk N, Yoganandan N (2001) Biomechanics of the cervical spine, part 3: minor injuries. Clin Biomech (Bristol, Avon) 16:267–275
Bondurant FJ, Cotler HB, Kulkarni MV et al (1990) Acute spinal cord injury. A study using physical examination and magnetic resonance imaging. Spine 15:161–168
Chance GQ (1948) Note on a type of flexion fracture of the spine. Br J Radiol 21:452
Daffner RH (1996) Imaging of vertebral trauma. Lippincott-Raven, Philadelphia
Daffner RH, Deeb ZL, Rothfus WE (1986) Fingerprints of vertebral trauma – a unifying concept based on mechanisms. Skeletal Radiol 15:518–525
Daffner SD, Daffner RH (2002) Computed tomography diagnosis of facet dislocations: the „hamburger bun“ and „reverse hamburger bun“ signs. J Emerg Med 23:387–394
Denis F (1983) The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 8:817–831
Denis F, Burkus JK (1992) Shear fracture-dislocations of the thoracic and lumbar spine associated with forceful hyperextension (lumberjack paraplegia). Spine 17:156–161
Effendi B, Roy D, Cornish B et al (1981) Fractures of the ring of the axis. A classification based on the analysis of 131 cases. J Bone Joint Surg 63-B:319–327
Fielding JW, Hawkins RJ (1977) Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg [Am] 59:37–44
Gehweiler JA, Duff DE, Martinez S et al (1976) Fractures of the atlas vertebra. Skeletal Radiol 1:97–102
Harris JH Jr, Carson GC, Wagner LK (1994) Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR 162:881–886
Harris JH Jr, Carson GC, Wagner LK, Kerr N (1994) Radiologic diagnosis of traumatic occipitovertebral dissociation: 2. Comparison of three methods of detecting occipitovertebral relationships on lateral radiographs of supine subjects. AJR 162:887–892
Hendey GW, Wolfson AB, Mower WR, Hoffman JR (2002) Spinal cord injury without radiographic abnormality: results of the National Emergency X-Radiography Utilization Study in blunt cervical trauma. J Trauma 53:1–4
Hoffman JR, Mower WR, Wolfson AB et al (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 343:94–99
Holdsworth F (1970) Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg [Am] 52:1534–1551
Kim CW, Perry A, Garfin SR (2005) Spinal instability: the orthopedic approach. Semin Musculoskelet Radiol 9:77–87
Langner S, Fleck S, Kirsch M et al (2008) Whole-body CT trauma imaging with adapted and optimized CT angiography of the craniocervical vessels: do we need an extra screening examination? AJNR 29:1902–1907
Lee JY, Vaccaro AR, Lim MR et al (2005) Thoracolumbar injury classification and severity score: a new paradigm for the treatment of thoracolumbar spine trauma. J Orthop Sci 10:671–675
Leone A, Cerase A, Colosimo C et al (2000) Occipital condylar fractures: a review. Radiology 216:635–644
Magerl F, Aebi M, Gertzbein SD et al (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3:184–201
Malberg MI (2001) A new system of classification for spinal injuries. Spine J 1:18–25; discussion 125
Malhotra AK, Camacho M, Ivatury RR et al (2007) Computed tomographic angiography for the diagnosis of blunt carotid/vertebral artery injury: a note of caution. Ann Surg 246:632–642; discussion 642–633
Maynard FM Jr, Bracken MB, Creasey G et al (1997) International Standards for Neurological and Functional Classification of Spinal Cord Injury. American Spinal Injury Association. Spinal Cord 35:266–274
Nicoll EA (1949) Fractures of the dorso-lumbar spine. J Bone Joint Surg [Am] 31B:376–394
Palmieri F, Cassar-Pullicino VN, Dell’Atti C et al (2006) Uncovertebral joint injury in cervical facet dislocation: the headphones sign. Eur Radiol 16:1312–1315
Pang D, Wilberger JE Jr (1982) Spinal cord injury without radiographic abnormalities in children. J Neurosurg 57:114–129
Powers B, Miller MD, Kramer RS et al (1979) Traumatic anterior atlanto-occipital dislocation. Neurosurgery 4:12–17
Reinhold M, Blauth M, Rosiek R, Knop C (2006) Lower cervical spine trauma: classification and operative treatment. Unfallchirurg 109:471–480, quiz 481–473
Ronnen HR, Korte PJ de, Brink PR et al (1996) Acute whiplash injury: is there a role for MR imaging? A prospective study of 100 patients. Radiology 201:93–96
Samaha C, Lazennec JY, Laporte C, Saillant G (2000) Hangman’s fracture: the relationship between asymmetry and instability. J Bone Joint Surg 82:1046–1052
Schueller-Weidekamm C (2008) Cervical spine injury. Diagnosis, prognosis and management. Radiologe 48:480–487
Stiell IG, Wells GA, Vandemheen KL et al (2001) The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 286:1841–1848
Traynelis VC, Marano GD, Dunker RO, Kaufman HH (1986) Traumatic atlanto-occipital dislocation. Case report. J Neurosurg 65:863–870
Vaccaro AR, Hulbert RJ, Patel AA et al (2007) The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine 32:2365–2374
White AA, Panjabi MM (1990) The problem of clinical instability in the human spine: a systemic approach. In: White AA, Panjabi MM (eds) Clinical biomechanics of the spine. Lippincott, Williams & Wilkins, Baltimore, pp 277–378
Willen J, Anderson J, Toomoka K, Singer K (1990) The natural history of burst fractures at the thoracolumbar junction. J Spinal Dis 3:39–46
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Schueller, G. „Who is who revisited“. Radiologe 50, 1084–1095 (2010). https://doi.org/10.1007/s00117-010-2030-9
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DOI: https://doi.org/10.1007/s00117-010-2030-9