Skip to main content
SpringerLink
Log in

Adjuvante Therapie nach Rückenmarkverletzung

Reduktion von Primär- und Vermeidung von Sekundärschäden

Adjuvant therapy

Reduction of primary and avoidance of secondary damage

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Die notfallmedizinischen Akutmaßnahmen am Unfallort, das Transportmanagement mit Immobilisierung des Patienten und Stabilisierung der Wirbelsäule sowie die intensivmedizinische Betreuung und adäquate Versorgung der Verletzungen dienen der Minimierung des erlittenen primären Rückenmarkschadens sowie dessen konsekutiver Folgen. Die sich innerhalb weniger Minuten entwickelnde Sekundärschädigung umfasst eine mannigfaltige Pathophysiologie mit ischämischen Reaktionen, lokalen Blutungen, Ödembildung sowie destruktiven biochemischen und metabolischen Veränderungen. Trotz der Vielzahl der bisher zur Neuroprotektion veröffentlichten Arbeiten sind noch keine nachhaltigen Therapiestandards etabliert. Einige wenige neuroprotektive Substanzen werden klinisch eingesetzt, meist Methylprednisolon. Insgesamt konnten jedoch weder Methylprednisolon noch andere Substanzen (z. B. Ganglioside) und Therapieansätze (z. B. Hypothermie, hyperbare Oxygenierung) Evidenz für ihre Wirksamkeit in der klinischen Anwendung erbringen. Die therapeutischen Möglichkeiten zur Reduktion des Sekundärschadens bleiben bis heute unbefriedigend.

Abstract

After spinal cord injury (SCI) two phases of damage are responsible for subsequent defects. In the first phase standardized management of rescue and transportation, early evaluation and acute care at a trauma center is mandatory to prevent further injury. In the second phase starting within minutes of injury various alterations, such as local ischemia, edema, release of inflammatory mediators and impaired autoregulation potentiate the damage. Various advances in science and technology target neuroprotection, but none of the recent human clinical trials have conclusively demonstrated a benefit for increasing function after SCI, including even methylprednisolone and gangliosides or other strategies, such as hypothermia or hyperbaric oxygenation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Abd AG, Braun NM (1989) Management of life-threatening bradycardia in spinal cord injury. Chest 95(3):701–702

    Article  CAS  PubMed  Google Scholar 

  2. Al-Waili NS, Butler GJ, Beale J et al (2005) Hyperbaric oxygen in the treatment of patients with cerebral stroke, brain trauma and neurologic disease. Adv Ther 22(6):659–678

    Article  CAS  PubMed  Google Scholar 

  3. Bracken MB, Holford TR (1991) National acute spinal cord injury study of methylprednisolone or naloxone. Neurosurgery 28:628–629

    Google Scholar 

  4. Bracken MB, Holford TR (1993) Effects of timing of methylprednisolone or naloxone administration on recovery segmental and long-tract neurological function in NASCIS-2. J Neurosurg 79:500–507

    Article  CAS  PubMed  Google Scholar 

  5. Bracken MB, Collins WF, Freeman DF et al (1984) Efficacy of methylprednisolone in acute spinal cord injury. JAMA 251:45–52

    Article  CAS  PubMed  Google Scholar 

  6. Bracken MB, Shepard MJ, Hellenbrand KG et al (1985) Methylprednisolone and neurological function 1 year after spinal cord injury: results of the national acute spinal cord injury study. J Neurosurg 63:704–713

    Article  CAS  PubMed  Google Scholar 

  7. Bracken MB, Shepard MJ, Collins WF et al (1990) A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the second national acute spinal cord injury study. N Engl J Med 322:1405–1411

    Article  CAS  PubMed  Google Scholar 

  8. Bracken MB, Shepard MJ, Collins WF et al (1992) Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second national acute spinal cord injury study. J Neurosurg 76:23–31

    Article  CAS  PubMed  Google Scholar 

  9. Bracken MB, Shepard MJ, Collins WF et al (1992) Response: methylprednisolone for spinal cord injury. J Neurosurg 77:325–327

    Google Scholar 

  10. Bracken MB, Shepard MJ, Holford TR et al (1997) Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the third national acute spinal cord injury randomized controlled trial. National acute spinal cord injury study. JAMA 277:1597–1604

    Article  CAS  PubMed  Google Scholar 

  11. Bracken MB, Shepard MJ, Holford TR et al (1998) Methylprednisolone or tirilazad mesylate administration after acute spinal cord injury: 1-year follow up. Results of the third national acute spinal cord injury randomized controlled trial. J Neurosurg 89:699–706

    Article  CAS  PubMed  Google Scholar 

  12. Büttner J (2004) Management der Querschnittlähmung. Anästh Intensivmed 45:190–204

    Google Scholar 

  13. Chinnock P, Roberts I (2005) Gangliosides for acute spinal cord injury. Cochrane Database Syst Rev 2:CD004444

    PubMed  Google Scholar 

  14. Consortium for Spinal Cord Medicine (2008) Early acute management in adults with spinal cord injury. A clinical practice guideline for healthcare providers. Paralyzed veterans of America. Consortium for Spinal Cord Medicine, Washington

  15. Deutsche Gesellschaft für Neurologie (2008) Leitlinien für Diagnostik und Therapie in der Neurologie, 4. überarb Aufl. Thieme, Stuttgart New York, S 654ff

  16. Fehlings MG, Spine Focus Panel (2001) Summary statement: the use of methylprednisolone in acute spinal cord injury. Spine [Suppl 24] 26:S55

  17. Geisler FH, Dorsey FC, Coleman WP (1991) Recovery of motor function after spinal-cord injury – a randomized placebo-controlled trial with GM-1 ganglioside. N Engl J Med 324(26):1829–1838

    Article  CAS  PubMed  Google Scholar 

  18. Geisler FH, Coleman WP, Grieco et al (2001) Recruitment and early treatment in a multicenter study of acute spinal cord injury. Spine [Suppl1] 26:S58–S67

  19. Geisler FH, Coleman WP, Grieco G (2001) The Sygen multicenter acute spinal cord injury study. Spine 26(245):S87–S98

    Article  CAS  PubMed  Google Scholar 

  20. Himmelseher S, Büttner J, Baethmann A et al (1999) Zur Gabe von Kortikosteroiden nach akuter spinaler Traumatisierung. Anästh Intensivmed 10:716–726

    Google Scholar 

  21. Hugenholtz H (2003) Methylprednisolone for acute spinal cord injury: not a standard of care. CMAJ 168(9): 1145–1146

    PubMed  Google Scholar 

  22. Hurlbert RJ (2000) Methylprednisolone for acute spinal cord injury: an inappropriate standard of care. J Neurosurg Spine [Suppl 1] 93:1–7

    Google Scholar 

  23. Joint Section on Disorders of the Spinal and Peripheral Nerves, American Association of Neurological Surgeons and the Congress of Neurological Surgeons (2002) Guidelines for the management of acute cervical spine and spinal cord injuries. Neurosurgery [Suppl 3] 50:S1

  24. Levi L, Wolf A, Belzberg H (1993) Hemodynamic parameters in patients with acute cervical cord trauma: description, intervention and prediction of outcome. Neurosurgery 33(6):1007–1016

    Article  CAS  PubMed  Google Scholar 

  25. Lieshout JJ van, Harkel AD ten, Wieling W (2000) Fludrocortisone and sleeping in the head-up position limit the postural decrease in cardiac output in autonomic failure. Clin Auton Res 10(1):35–42

    Article  PubMed  Google Scholar 

  26. Otani K, Abe H, Kadoya S (1996) Beneficial effect of methylprednisolone sodium succinate in the treatment of acute spinal cord injury. Sekitsui Sekizui J 7:633–647

    Google Scholar 

  27. Petitjean ME, Pointillart V, Dixmerias F et al (1998) Medical treatment of spinal cord injury in the acute stage. Ann Fr Anesth Reanim 17(2):114–122

    CAS  PubMed  Google Scholar 

  28. Resnick DK, Kaiser MJ, Fehlings M, McCornick PC (2007) Hypothermia and human spinal cord injury: position statement and evidence based recommandations from the AANS/CNS Joint Sections on Disorders of Spine and the AANS/CNS Joint Section on Trauma. AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves, Washington, spinesection.org

  29. Vale FL, Burnes J, Jackson AB, Hadley MN et al (1997) Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management. J Neurosurg 87(2):239–246

    Article  CAS  PubMed  Google Scholar 

  30. Wang YC, Zhang S, Du TY et al (2010) Hyperbaric oxygen preconditioning reduces ischemia – reperfusion injury by stimulating autophagy in neurocyte. Brain Res Feb 1. [Epub ahead of print]

  31. Wright RA, Kaufmann HC, Perera R et al (1998) A double-blind, dose-response study of midodrine in neurogenic orthostatic hypotension. Neurology 51(1):120–124

    CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Zentrum Rückenmarkverletzte, BG-Unfallklinik Murnau, Prof.-Küntscher-Straße 8, 82418, Murnau, Deutschland

    D. Maier

Authors
  1. D. Maier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Maier.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maier, D. Adjuvante Therapie nach Rückenmarkverletzung. Trauma Berufskrankh 12, 158–162 (2010). https://doi.org/10.1007/s10039-010-1665-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10039-010-1665-0

Schlüsselwörter

Keywords

Search

Navigation