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Fehlstellungen nach Wirbelsäulenverletzungen im thorakolumbalen Übergang

Deformities following spinal injury at the thoracolumbar junction

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Zusammenfassung

Aufgrund der anatomischen Besonderheiten finden sich Fehlstellungen nach Wirbelsäulenverletzungen vermehrt im Übergang der flexiblen Lendenwirbelsäule zur starren Brustwirbelsäule. Die Klassifikation der Fraktur, der Zustand der angenzenden Bandscheiben und das sagittale Profil müssen in die Gesamtbeurteilung und Therapieplanung miteinfließen. Das konventionelle Röntgen wird durch Funktionsaufnahmen und Schnittbildverfahren ergänzt. Die Therapie unterliegt keinem allgemeingültigen Konsensus, doch bringt ein dorsoventrales Vorgehen biomechanische Vorteile und längerfristig bessere Ergebnisse. Ziel ist es, das sagittale Profil zu korrigierien. Etablierte Stabilisationssysteme und schonende Operationstechniken ermöglichen eine suffiziente Primärversorgung. Mögliche Spätfolgen einer kyphotischen Fehlstellung sind Schmerzsyndrome, Anschlussdegenerationen wie auch sekundäre neurogene Störungen. Schlechte funktionelle Ergebnisse korrelieren mit hochgradigen Kyphosen über 20°, Pseudarthrosen und neurologischen Ausfällen. Der Artikel gibt eine Übersicht zur Pathogenese, zur Diagnostik und zu möglichen Therapieoptionen posttraumatischer Kyphosen.

Abstract

Due to anatomical characteristics, posttraumatic deformities following spinal injury occur in particular at the transition from the flexible lumbar spine to the rigid thoracic spine. Incorrectly classified vertebral body fractures can lead to the development of posttraumatic kyphosis due to incorrect treatment. It is likewise important to evaluate the integrity of adjacent discs and assess the sagittal index. Management of kyphosis is difficult and requires radiological evaluation following exact planning. Reconstruction of the sagittal anatomical contour is crucial to prevent stress in the compensatory curves. Performing a dorso-ventral or dorso-ventro-dorsal approach, pedicle subtraction osteotomy or an eggshell procedure is also helpful to achieve good correction without anterior reconstructive surgery. The clinical result is not dependent on correct repositioning alone; poor results can be expected in cases with pseudarthrosis, neurological deficits and severe kyphotic deformities. This article gives an overview of pathogenesis, diagnostic steps and therapeutic options for corrective spinal surgery.

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Authors and Affiliations

  1. Abteilung für Wirbelsäulenorthopädie, Orthopädische Universitätsklinik Friedrichsheim gGmbH, Marienburgstr. 2, 60528, Frankfurt am Main, Deutschland

    S. Schmidt &  M. Rauschmann

  2. Institut für Versicherungsmedizin, Frankfurt am Main, Deutschland

    K.-D. Thomann

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  1. S. Schmidt
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  2. K.-D. Thomann
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  3. M. Rauschmann
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Correspondence to M. Rauschmann.

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Schmidt, S., Thomann, KD. & Rauschmann, M. Fehlstellungen nach Wirbelsäulenverletzungen im thorakolumbalen Übergang. Orthopäde 39, 256–263 (2010). https://doi.org/10.1007/s00132-009-1543-2

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