Rationale Bildgebung beim HWS-Trauma

Zusammenfassung

Die HWS ist – aufgrund ihrer hohen Mobilität – sowohl hinsichtlich ihrer knöchernen als auch ihrer diskoligamentären Integrität und Stabilität bei Akzelerations-/Dezelerationstraumen stärker gefährdet als andere Wirbelsäulenabschnitte. Dabei treten die meisten derartigen Verletzungen in der unteren HWS auf. Die konventionelle Projektionsradiografie kann weder diesen Abschnitt durchweg suffizient abbilden noch ist das HWS-Röntgen ausreichend sensitiv genug, zervikale Frakturen sicher zu erkennen. Die moderne Multislice-CT-Technik bietet sich hierzu als eine ausreichend sichere und sensitive Methode an, diesen diagnostischen Nachteil – insbesondere zur Beurteilung knöcherner Läsionen – zu überwinden. Der MRT wiederum kommt ein wachsender Stellenwert bei der Einschätzung diskoligamentärer Verletzungsmuster zu, und sie ist unverzichtbar zur Beurteilung intraspinaler Pathologien, insbesondere von traumatischen Myelonläsionen. Im Weiteren werden die für die HWS exklusiven Verletzungsmuster des kraniozervikalen Überganges einschließlich HWK II gesondert und ausführlich besprochen.

Abstract

Because of its high mobility, the cervical spine is at greater risk, resulting from acceleration-deceleration trauma than do the other parts of the spine. This applies to both its osseous and discoligamentous integrity and stability. Most of these injuries occur in the lower cervical spine. Conventional projection radiography fails to provide adequate images of the cervicothoracic junction in addition to the fact that cervical fractures cannot be reliably detected on plain radiographs in the case of substantial or adequate trauma, resp. However, modern multislice computed tomography provides both a sufficient and sensitive method to overcome this diagnostic disadvantage – particularly in the evaluation of osseous lesions. MR imaging has become increasingly useful in the evaluation of discoligamentous patterns of injury and thus, became essential in the evaluation of intraspinal pathologies, particularly traumatic myelon lesions. Furthermore, a detailed discussion on the unique injury pattern of the craniocervical junction, including C2, is also provided in this article..

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