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Diagnostik und Therapie von Wirbelsäulenmetastasen

Diagnostics and therapy of spinal metastases

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Zusammenfassung

30% aller Skelettmetastasen und 10% aller primären Knochentumoren sind in der Wirbelsäule lokalisiert, wobei Erstere v. a. in der Lenden- (LWS, 52%), Brust- (BWS, 36%) und Halswirbelsäule (HWS, 12%) zu finden sind. Symptome sind lokaler Schmerz oder im weiteren Verlauf pathologische Frakturen. Bei Letzteren kann es durch Kompression neuraler Strukturen zu sensiblen und motorischen Ausfällen bis hin zur Querschnittlähmung kommen. Falls die radiologische und ggf. laborchemische Diagnostik zur Diagnosesicherung nicht ausreichen, sollte eine Biopsie erfolgen. Eine präzise Diagnose sowie eine möglichst exakte Prognoseabschätzung sind Basis der Therapieentscheidung. Ziel der Behandlung ist, Stabilität und Schmerzfreiheit für den Patienten sowie eine ausreichende und dauerhafte Dekompression des Spinalkanals zu erreichen. Da es sich um eine palliative Situation handelt, stehen Schmerzerleichterung sowie der Erhalt der Mobilität im Vordergrund. Solitäre Metastasen sollten mit kurativem Ansatz therapiert werden.

Abstract

Out of all skeletal metastases 30% are located in the spine as are 10% of primary bone tumors, whereby 52% of metastases occur in the lumbar region, 36% in the thoracic spine and 12% in the cervical spine. Patients suffer from local pain caused by irritation of the periosteum due to rapid growth of the tumor or subsequent pathologic fractures which may lead to compression and neurological impairment with paresthesia, paresis and paraplegia. If the diagnosis cannot be confirmed exactly by radiological imaging and laboratory tests, a biopsy should be performed. A precise diagnosis of the tumor entity as well as an estimation of the prognosis provides an important basis for further decision-making. The aim of therapy is pain relief and stabilization by operative and non-operative measures. Therapy is palliative with the aim of pain relief and preservation of mobility. In cases of solitary metastasis a curative operative treatment should be performed.

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland

    H. Pilge, B.M. Holzapfel, P.M. Prodinger, M. Hadjamu, H. Gollwitzer & H. Rechl

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  1. H. Pilge
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  2. B.M. Holzapfel
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  3. P.M. Prodinger
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  4. M. Hadjamu
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  5. H. Gollwitzer
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  6. H. Rechl
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Correspondence to H. Pilge.

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Pilge, H., Holzapfel, B., Prodinger, P. et al. Diagnostik und Therapie von Wirbelsäulenmetastasen. Orthopäde 40, 185–196 (2011). https://doi.org/10.1007/s00132-010-1738-6

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