Komplexpathologien an der Wirbelsäule: Trauma trifft Degeneration – eine Bestandsaufnahme

Zusammenfassung

Wirbelkörperfrakturen bei vorbestehender relevanter Wirbelsäulendegeneration stellen eine große Herausforderung dar. Aufgrund der steigenden Lebenserwartung hängt das gemeinsame Auftreten von Degeneration und Frakturen mit dem physiologischen Alterungsprozess zusammen. Verantwortlich sind zahlreiche degenerationsfördernde und frakturverursachende Faktoren. Die diagnostische und therapeutische Herausforderung besteht darin, die verantwortlichen Schmerzquellen zu identifizieren und ein geeignetes Therapiekonzept durchzuführen. Dazu ist ein strukturierter und erweiterter Algorithmus hilfreich. Unverändert bedürfen instabile Traumafolgen einer operativen Versorgung. Die Versorgungstechnik kann jedoch durch begleitende degenerative Veränderungen beträchtlich beeinflusst werden. So können zusätzlich Dekompressionen, langstreckige Versorgungen bis hin zur begleitenden aufwendigen Umstellungsosteotomie notwendig werden. Die einzelnen Indikationen müssen dabei individuell dem Patienten und der jeweiligen Pathologie angepasst werden.

Abstract

Treating vertebral body fractures is challenging when there is relevant pre-existing spinal degeneration. Both vertebral body fractures and spinal degeneration are related to the physiological aging process. The increases in both are linked to increases in life expectancy. Several factors promote spinal degeneration and increase fracture risk, such as disc degeneration, spinal imbalance and osteoporosis. The main diagnostic and therapeutic challenge is to identify the sources of pain and to start appropriate therapy. A structured and advanced algorithm is then essential. Unstable fractures must always be stabilised. However, surgical strategy may be greatly influenced if there are also degenerative diseases, such as segmental decompression, multisegmental instrumentation or fusion, or complex reconstructive spondylodesis, including osteotomies. Notwithstanding this, the individual therapy concept has to be adapted to the demands and pathology of the individual patient.

Schlüsselwörter

osteoporotische Wirbelkörperfrakturen - Bandscheibendegeneration - Spinalkanalstenose - sagittale Balance - Therapiealgorithmus

Key words

osteoporotic vertebral fractures - disc degeneration - spinal canal stenosis - sagittal balance - therapy concept

^* Geteilte Erstautorenschaft Josten und Heyde.

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