Enger Spinalkanal und osteoligamentäre Verletzung HWS – konservative Therapie

Zusammenfassung

Seit der Beschreibung des traumatischen zentromedullären Syndroms (traumatic central cord syndrome, TCCS) als Rückenmarksschädigung durch Kontusionierung bei vorbestehendem engen zervikalen Spinalkanal durch Schneider 1954 wurden betroffene Patient:innen aufgrund der häufig spontanen neurologischen Erholung in erster Linie konservativ behandelt. Mit der Erkenntnis, dass relativ häufig strukturelle und potentiell instabile Verletzungen in diesen Fällen vorliegen und der zunehmend aggressiven (frühen) chirurgischen Versorgung von Rückenmarkstraumen im Allgemeinen, wird aktuell auch beim TCCS eine operative Therapie propagiert. Bei osteoligamentärer Verletzung und Instabilität macht dies Sinn, während die Datenlage beim klassischen TCCS, also der Rückenmarkskontusionierung alleine durch Hyperextension bei engem Spinalkanal ohne (instabile) Verletzung, unklar ist. Vergleichende Studien konnten keinen Vorteil der operativen Versorgung nachweisen. Da die radiologische Detektion von diskoligamentären Verletzungen bei begleitenden degenerativen Veränderungen schwierig sein kann und nicht selten eine anhaltende Rückenmarkskompression bildgebend vorliegt, ist eine aggressive operative Vorgehensweise durchaus zu rechtfertigen. TCCS-Patient:nnen mit geringer neurologischer Symptomatik, die keine Rückenmarkskompression in der Bildgebung zeigen, können jedoch präferentiell konservativ versorgt werden.

Abstract

Since the description of the traumatic central cord syndrome (TCCS) as a contusional lesion of the spinal cord due to hyperextension and a preexisting cervical stenosis by Schneider in 1954 most patients were managed conservatively, as spontaneous neurological recovery commonly occurred. When spine surgeons realized that many TCCS patients harbored osteoligamentous and potentially unstable injuries and a more aggressive attitude favoring early surgery for spinal cord injury was adapted in general, surgical treatment has also been popularized in TCCS cases. This makes a lot of sense for patients with osteoligamentous and unstable lesions, but the management of the classical TCCS, i.e. spinal cord contusion due to hyperextension and spinal stenosis alone, is largely unclear and comparative studies found no benefit for surgery. With the difficulty to detect discoligamentous injuries in highly degenerated patients and an often ongoing cord compression on imaging, a more aggressive surgical attitude can be justified. Nevertheless, TCCS patients with mild neurologic deficits can be preferentially managed conservatively.

Schlüsselwörter

traumatisches zentromedulläres Syndrom - Rückenmarkstrauma - osteoligamentäre Verletzung - Operation - konservative Therapie

Keywords

traumatic central cord syndrome - spinal cord injury - osteoligamentous injury - surgery - conservative management

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