Das Nervenwurzelsyndrom beim Kleintier

Zusammenfassung

Eine große Vielfalt an Ätiologien gilt als ursächlich für das Nervenwurzelsyndrom beim Hund. Dabei zählen der lateralisierte Bandscheibenvorfall, die Foraminalstenose sowie maligne und benigne Nervenscheidentumoren zu den wichtigsten beschriebenen Auslösern. Das klinische Bild des Nervenwurzelsyndroms zeichnet sich aus durch eine Monoparese in Verbindung mit einer fortschreitenden Lahmheit, die mit einer Schonhaltung der betroffenen Gliedmaße im Stand einhergehen kann. Obwohl die Problematik bei Klinikern gut bekannt ist, gibt es in der tiermedizinischen Literatur keinen Übersichtsartikel, der das Thema „Nervenwurzelsyndrom beim Kleintier“ spezifisch behandelt. Meist wird es lediglich als Symptom seiner potenziellen Ätiologien erwähnt, dem sog. Nervenwurzelzeichen (nerve root sign). Bei der Pathophysiologie der Nervenwurzelkompression oder -irritation spielen eine Reihe biomechanischer und biochemischer Faktoren eine Rolle, die einzeln oder im Zusammenspiel auftreten und dieselben Veränderungen hervorrufen können. Im Zentrum der Pathophysiologie des Syndroms scheinen Änderungen der Mikrozirkulation zu stehen. Diese Mikrozirkulationsstörungen ziehen nicht nur pathomorphologische Veränderungen, wie Ödembildung, Demyelinisation und Axonuntergang, nach sich, sondern leiten auch am Ort der Schädigung sowie im zentralen Nervengewebe eine Kaskade an Reaktionen ein. So kommt es zur Ausschüttung verschiedener Neuropeptide, zur Modulation der Nervenexzitabilität und zur Impulsweiterleitung. Unterschiedliche Pathomechanismen führen somit vielfach zu einem einheitlichen Schädigungsbild, was eine nachträgliche Aufschlüsselung in die ursprünglich auslösenden Faktoren erheblich erschwert. Die Antwort des Körpers auf diese einwirkenden Faktoren gibt den Ausschlag dafür, ob tatsächlich ein Nervenwurzelsyndrom entsteht. Eine Behebung der Grundursache, falls sie gefunden wird, sowie eine individuelle und multimodale Schmerztherapie scheinen beim Nervenwurzelsyndrom die erfolgreichsten therapeutischen Maßnahmen zu sein.

Abstract

A large variety of etiologies is considered to be the cause of nerve root syndrome in dogs. Lateralized disc herniation, foraminal stenosis and malignant as well as benign nerve sheath tumors are some of the most important triggers described. The clinical signs of a nerve root syndrome are characterized by monoparesis in combination with progressive lameness, which may be accompanied by an elevation of the affected limb. Although the problem is well known among clinicians, there is no review article in the veterinary literature that specifically covers the subject of “nerve root syndrome in small animals”. Mostly, this is merely mentioned as a symptom of its potential etiologies, as the so-called “nerve root sign” or “nerve root signature”. In the pathophysiology of nerve root compression or irritation, a number of biomechanical and biochemical factors play a role. These occur individually or in combination and may lead to the same changes. The pathophysiology of the syndrome seems to focus around changes in microcirculation. These microcirculation disorders not only lead to pathomorphological changes such as edema formation, demyelination and axon death, but also initiate a cascade of reactions at the site of damage as well as in the central nervous tissue. This leads to the release of various neuropeptides, modulation of nerve excitability and impulse transmission. Different pathomechanisms therefore often lead to a uniform damage pattern, which makes it difficult to point out the original triggering factors. The body’s response to these factors determines whether a nerve root syndrome actually develops or not. The treatment of the cause, if found, and an individual and multimodal pain therapy seem to be the most successful therapeutic approaches for nerve root syndrome in dogs.

Schlüsselwörter

Nervenwurzelzeichen - Nervenwurzelkompression - radikuläres Syndrom - neuropathische Schmerzen - lateralisierter Bandscheibenvorfall - maligner peripherer Nervenscheidentumor

Key words

Nerve root sign - nerve root compression - radicular syndrome - neuropathic pain - lateralized herniated disc - malignant peripheral nerve sheath tumor

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