Zusammenfassung
Degenerative Veränderungen an der Wirbelsäule treten individuell unterschiedlich mit voranschreitendem Lebensalter auf. Einerseits hängt dies von äußeren Faktoren, wie z. B. jahrelanger schwerer körperlicher Tätigkeit ab, kann aber auch genetisch beeinflusst sein, wie neuere Untersuchungen zeigen konnten. Das Myelon ist innerhalb des knöchernen Spinalkanals gut geschützt, kann aber durch degenerative Veränderungen der Bandscheiben und Bewegungssegmente beeinträchtigt werden. Dabei können durch Verlagerung oder Einengung der nervalen Strukturen anhaltende Schmerzen oder auch fokal neurologische Ausfälle wie Lähmungen oder Sensibilitätsstörungen auftreten. Die Beschwerden können sich über Jahre schleichend entwickeln, z. B. bei einer zunehmenden knöchernen Einengung des Spinalkanals (Spinalkanalstenose) aber auch akut auftreten, beim plötzlichen Bandscheibenvorfall. Viel häufiger treten jedoch Rückenschmerzen auf („low back pain“), die bei ca. 80 % aller Menschen im Laufe ihres Lebens irgendwann einmal auftreten. Es ist notwendig, die normalen altersbedingten Veränderungen der Anatomie in der MR-Bildgebung, insbesondere der Bandscheiben zu kennen, um diese auch richtig zu interpretieren. Kenntnisse des Spektrums der verschiedenen altersbedingten degenerativen Prozesse, die in der Bandscheibe und am Wirbelkörper auftreten können sind notwendig, um pathologische Veränderungen davon zu unterscheiden. Dies ist insofern wichtig, da therapeutische Entscheidungen oft von der MR-Bildgebung abhängig gemacht werden.
Abstract
Degenerative alterations of the spine occur in an individual-specific manner with increasing age. This is not only dependent on external factors, such as hard physical labor over many years but can also be genetically influenced as demonstrated in recent studies. The spinal cord is well-protected within the spinal canal but can be impaired by degenerative alterations of the intervertebral discs and functional spinal segments. Depositions or narrowing of nerve structures can cause lasting pain or focal neurological deficits, such as paralysis or sensitivity disorders. These complaints can slowly develop over years, e.g. by a gradually increasing bony narrowing of the spinal canal (spinal canal stenosis) or can occur suddenly, e.g. an acute herniated disc. However, low back pain is much more common and occurs in approximately 80 % of people sometime during their lifetime. It is necessary to recognize the normal age-related anatomical alterations in magnetic resonance imaging (MRI), particularly for intervertebral discs in order to interpret these correctly. Knowledge of the spectrum of the various age-related degenerative processes which can occur in intervertebral discs and vertebral bodies is necessary to be able to differentiate them from pathological alterations. This is important because therapy decisions are often made as a direct result of MRI.
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Interessenkonflikt. W. Reith, S. Bodea, M. Kettner, R. Mühl-Benninghausen, A. Simgen geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Reith, W., Bodea, S., Kettner, M. et al. Degenerative und altersbedingte Veränderungen an der Wirbelsäule. Radiologe 54, 1069–1077 (2014). https://doi.org/10.1007/s00117-014-2730-7
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DOI: https://doi.org/10.1007/s00117-014-2730-7