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Die rheumatisch bedingte Instabilität der oberen Halswirbelsäule

Instability of the upper cervical spine due to rheumatism

  • Leitthema
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Zusammenfassung

Mit einem Befall der Halswirbelsäule (HWS) beim Rheumatiker ist im Langzeitverlauf in >50% der Fälle zu rechnen. Primär kommt es zu einer Manifestation des rheumatischen Geschehens an der oberen HWS. Der initiale Befall des Segments C1/C2 führt zu einer horizontalen Instabilität, bei fortschreitender Destruktion kann es zu einer sog. vertikalen Instabilität kommen. Diese ist durch ein relatives Höhertreten des Dens gekennzeichnet. Daraus resultiert die Gefahr einer Myelonkompression mit der Ausbildung der prognostisch ungünstigsten Komplikation der rheumatischen Arthritis an der HWS, der zervikalen Myelopathie.

Ziel der Therapie des Rheumatikers muss es sein, diese Veränderungen in der Frühphase zu erfassen, zu kontrollieren und zu therapieren. Bei progredienter Instabilität, bei therapieresistenten Beschwerden und bei neurologischen Defiziten machen sich operative stabilisierende Maßnahmen erforderlich. Diese sind in der Lage, das Fortschreiten der Destruktionen aufzuhalten und verbessern die Prognose des Rheumatikers hinsichtlich der Schmerzen, der neurologischen Defizite und nicht zuletzt der Lebenserwartung.

Abstract

Rheumatic manifestation at the cervical spine occurs in more than 50% of all cases in the natural course of this disease. The first cervical manifestation takes place in the upper cervical spine. The initial involvement of the C1/C2 segment leads to atlantodental subluxation. Progressive destruction can result in vertical instability, which is characterized by cranial subluxation of the odontoid process with the danger of resulting stenosis and cervical myelopathy.

The goal of diagnosis has to be the early recognition of these changes to establish an effective treatment protocol. Persistent pain, neurological deficits, and progressive radiological signs for instability are indications for operative stabilizing procedures. These procedures avoid progressive destruction and improve the prognosis regarding pain decrease, regression of neurological deficits, and life expectancy.

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  1. Klinik für Unfall- und Wiederherstellungschirurgie, Charité, Campus Benjamin Franklin, Universitätsmedizin, Berlin

    C. E. Heyde & R. Kayser

  2. Klinik für Orthopädie, Charité, Campus Benjamin Franklin, Universitätsmedizin, Berlin

    U. Weber

  3. Klinik für Unfall- und Wiederherstellungschirurgie, Charité, Campus Benjamin Franklin, Universitätsmedizin, Hindenburgdamm 30, 12200, Berlin

    C. E. Heyde

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Herrn OMR Dr. med. D. Jungmichel, Chefarzt i. R., zum 75. Geburtstag gewidmet.

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Heyde, C.E., Weber, U. & Kayser, R. Die rheumatisch bedingte Instabilität der oberen Halswirbelsäule. Orthopäde 35, 270–287 (2006). https://doi.org/10.1007/s00132-005-0918-2

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