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Trauma und Berufskrankheit

, Volume 18, Issue 4, pp 289–295 | Cite as

Frakturen der Halswirbelsäule bei Spondylitis ankylosans

  • A. Pingel
  • M. Scholz
  • F. Kandziora
Leitthema

Zusammenfassung

Auch niederenergetische Traumen können zu gravierenden Frakturen der ankylosierten Wirbelsäule führen. Patienten mit Spondylitis ankylosans (AS), die ein Wirbelsäulentrauma erleiden, haben ein größeres Risiko, neurologische Ausfallsymptome zu entwickeln. Diese können auch mit einer Verzögerung von einigen Tagen auftreten. Neu aufgetretene Rückenschmerzen bei einem Bechterew-Patienten auch ohne erinnerliches Trauma sind bis zum Beweis des Gegenteils als Fraktur zu werten. Dies unterstreicht die Wichtigkeit einer genauen klinischen und radiologischen Untersuchung, die engmaschig wiederholt werden sollte, insbesondere dann, wenn der Patient über undefinierbare Schmerzen klagt oder neurologische Symptome bestehen. Einfache Röntgenuntersuchungen der Wirbelsäule reichen besonders in den Junktionszonen in der Regel nicht aus, um eine Fraktur auszuschließen. Eine CT sollte in jedem Fall erfolgen, im Zweifel auch eine MRT in der fettunterdrückten STIR-Wichtung. Die operative Versorgung von Bechterew-Verletzungen ist das sicherste und effektivste Verfahren der Behandlung. Die unmittelbare Stabilisierung der Frakturzone ermöglicht eine Frühmobilisation, wodurch das Risiko immobilitätsbedingter Komplikationen vermieden werden kann. Daneben kann hierdurch effektiv der neurologische Status verbessert werden. Dennoch ist die chirurgische Versorgung von Frakturen der Halswirbelsäule bei AS sehr herausfordernd. Das Operationsverfahren der ersten Wahl ist die langstreckige dorsale Spondylodese. Aufgrund der kyphotischen Deformierungen und der pulmonalen und kardialen Begleitrisiken ist die primäre ventrale Versorgung in der Regel nicht sinnvoll. Bei entsprechend langstreckiger dorsaler Fusion ist die sekundäre ventrale Versorgung meist nicht erforderlich.

Schlüsselwörter

Trauma Wirbelsäule Rückenschmerzen Operation Spondylodese 

Cervical spine fractures in ankylosing spondylitis

Abstract

Even low-energy trauma can lead to serious fractures of the spine in patients with ankylosing spondylitis (AS). These patients have a greater risk of suffering from neurological impairment and this can also occur after a delay of several days. Newly occurring back pain in AS patients without any recognized trauma should be treated as a fracture unless proven otherwise. This highlights the importance of accurate clinical and radiological examinations, which should be repeated at short intervals, especially if the patient complains of indefinable pain or shows neurological symptoms. Simple X‑ray examinations of the spine are usually not sufficient to exclude a fracture, particularly in the junction zones. A computed tomography (CT) scan should be carried out in any case and if in doubt, magnetic resonance imaging (MRI) in fat-suppressed short inversion time inversion recovery (STIR) weighting should also be performed. Surgical treatment of AS injuries is the safest and most effective method of treatment. Immediate stabilization of the fracture site enables early mobilization, which can avoid the risk of complications due to longer immobilization. In addition, in this way the neurological status can be effectively improved. Nevertheless, the surgical treatment of cervical spine fractures in AS is very challenging. The primary surgical procedure of choice is posterior long segment spinal fusion. Due to kyphotic deformities and risk of pulmonary and cardiac comorbidities, primary ventral plating is usually not indicated. If the posterior fusion is long enough, there is usually no need for an additional secondary anterior procedure.

Keywords

Trauma Spinal column Back pain Operation Spondylodesis 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

A. Pingel, M. Scholz und F. Kandziora geben an, dass kein Interessenkonflikt besteht.

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

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Copyright information

© Springer Medizin Verlag Berlin 2016

Authors and Affiliations

  1. 1.Berufsgenossenschaftliche Unfallklinik FrankfurtFrankfurtDeutschland

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