Subaxiale degenerative Instabilität und spondylotische Myelopathie

Therapeutisch stehen konservative und operative Therapiemöglichkeiten zur Verfügung; abhängig von den vorliegenden Beschwerden sollte bei fehlendem neurologischem Defizit eine mindestens 3-monatige konservative Therapie vor einer operativen Maßnahme durchgeführt werden.

In der operativen Behandlung stehen 2 Verfahrensgruppen zur Verfügung: Die ventrale zervikale Dekompression mit Diskektomie und ggf. Korporektomie sowie dorsale Verfahren, hier insbesondere zu erwähnen die zervikale Laminoplastie. Bei ventralen Verfahren werden die stenosierenden Strukturen reseziert und das Myelon entlastet, Kyphosen werden korrigiert und das Ergebnis durch eine Plattenosteosynthese gesichert. Dorsale Verfahren entlasten das Rückenmark, indem stenosierende Prozesse entfernt werden und der Spinalkanal nach dorsal eröffnet wird, sodass sich das Rückenmark von ventralen Stenosierungen abheben kann; dieses Verfahren ohne Instrumentierung kann nur angewendet werden, wenn keine zervikale Kyphose besteht. Dorsale Laminoplastieverfahren bieten die Möglichkeit, gelenkerhaltend vorzugehen, allerdings mit der Gefahr einer Instabilität und Kyphosierung, sodass eine genaue präoperative Evaluierung unabdingbar ist.

Entscheidend für das Gesamtergebnis bleibt die sorgfältige Indikationsstellung und Patientenselektion sowie eine gründliche Dekompression mit solider Rekonstruktion.

Literatur

• 1 Philadelphia Panel . Philadelphia Panel evidence based clinical practice guidelines on selected rehabilitation interventions for neck pain.  Phys Ther. 2001;  81 1701-1717
• 2 Mazanec D, Reddy A. Medical Management of cervical spondylosis.  Neurosurg. 2007;  60 S1-S43
• 3 Rao R D, Currier B L, Albert T J et al. Degenerative cervical spondylosis: Clinical syndroms, pathogenesis and management.  J Bone Joint Surg. 2007;  89-A 1360-1378
• 4 Tani T, Ushida T, Ishida K. Relative safety of anterior microsurgical decompression versus laminoplasty for cervical myelopathy with a massive ossified posterior ligament.  Spine. 2002;  27 2491-2498
• 5 Bayley J C, Yoo J U, Kruger D M et al. The role of distraction in improving the space available for the cord in cervical spondylosis.  Spine. 2001;  20 771-775
• 6 Okada E, Matsumoto M, Ichihara D et al. Does the sagittal alignment of the cervical spine have an impact on disc degeneration? Minimum 10-year follow-up of asymptomatic volunteers.  Eur Spine J. 2009;  18 1644-1651
• 7 Trummees E et al. Biomechanische Serie der Jahre 2003 – 2008.  Spine. 2003 – 2008; 
• 8 Lian X F, Xu J G, Zeng B F et al. Noncontiguous anterior decompression and fusion für multilevel cervical spondylotic myelopathy: a prospective randomized control clinical study.  Eur Spine J. 2010;  19 713-719
• 9 Koller H, Meier O, Hitzl W et al. Geometrical results following 4- and 5-level arthrodesis of the cervical spine.  Eur Spine J. 2007;  16 2055-2071
• 10 Koller H, Schmidt R, Mayer M et al. The stabilizing potential of anterior, posterior and combined techniques for the reconstruction of a 2-level cervical corpectomy model: Biomechanical study and first results of ATPS-prototyping.  Eur Spine J. ;  e-pub June 2010
• 11 Dalbayrak S, Yilmaz M, Naderi S. Skip corpectomy in the treatment of multilevel cervical spondylotic myelopathy and ossified longitudinal ligament.  J Spinal Disord. 2010;  12 33-38
• 12 Brazenor G A. Comparison of multisegment anterior cervical fixation usind bone graft versus a titanium rod and buttress prosthesis.  Spine. 2007;  32 63-71
• 13 Schmidt R, Wilke H J, Claes L et al. Effect of constrained posterior screw and rod systems for primary stability: biomechanical in vitro comparison of various instrumentations in a single-level corpectomy model.  Eur Spine J. 2005;  14 372-380
• 14 Floyd T, Ohnmeiss D. A meta-analysis of autograft versus allograft in anterior cervical fusion.  Eur Spine J. 2000;  9 398-403
• 15 Chau A MT, Mobbs R J. Bone graft substitutes in anterior cervical discectomy and fusion. Review.  Eur Spine J. 2009;  18 449-464
• 16 Uchida K, Nakajima H, Sato R et al. Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: outcome after anterior or posterior compression.  J Neurosurg Spine. 2009;  11 521-528
• 17 Steinmetz M P, Kager C D, Benzel E C. Ventral correction of postsurgical cervical kyphosis.  J Neurosurg. 2002;  97 1-7
• 18 Ferch R D, Shad A, Cadoux-Hudson T A et al. Anterior correction of cervical kyphotic deformity: effects on myelopathy, neck pain, and sagittal alignment.  J Neurosurg Spine. 2004;  100 S13-S19
• 19 Suda K, Abumi K, Ito M et al. Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy.  Spine. 2003;  28 1258-1262
• 20 Thongtrangan I, Balabhadra R SV, Kim D H. Management of strut graft failure in anterior cervical spine surgery.  Neurosurg Focus. 2003;  15 article 4
• 21 Chen Y, Cjen D, Guo Y et al. Subsidience of titanium Mesh cage. A study based on 300 cases.  J Spinal Disord Tech. 2008;  21 489-492
• 22 Koller H, Reynolds J, Zenner J et al. Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries.  Eur Spine J. 2009;  18 1701-1717
• 23 Schlenk R P, Stewart T, Benzel E C. The biomechanics of iatrogenic spinal destabilization and implant failure.  Neurosurg Focus. 2003;  15 E2
• 24 DuBois A B, Bolt P M, Todd A G et al. Static versus dynamic plating for multilevel anterior cervical discectomy and fusion.  The Spine J. 2007;  7 188-193
• 25 Song K-J, Taghavi C E, Hsu M S. Plate augmentation in anterior cervical discectomy and fusion with cage for degenerative cervical spine disorders.  Eur Spine J. 2010;  E-pub 02–2010
• 26 Anderson P A, Subach B R, Riew K D. Predictors of outcome after anterior cervical discectomy and fusion. A multivariate analysis.  Spine. 2009;  34 161-166
• 27 Ghahreman A, Rao P JV, Ferch R. Dynamic plates in anterior cervical fusion.  Spine. 2009;  34 1567-1571
• 28 Galbusera F, Bellini C M, Costa F et al. Anterior cervical fusion: a biomechanical comparison of 4 techniques. Laboratory investigation.  J Neurosurg Spine. 2008;  9 444-449
• 29 Ragab A A, Hodges F S, Hill C P et al. Dynamic anterior cervical plating for multilevel spondylosis: Does it help?.  Evidence-based spine-care Journal. 2010;  1 41-46
• 30 Park Y, Maeda T, Cho W et al. Comparison of anterior cervical fusion after two-level discectomy or single-level corporectomy: sagittal alignment, cervical lordosis, graft collapse and adjacent-level ossification.  Spine J. 2010;  10 193-199
• 31 Fraser J F, Hartl R. Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates.  J Neurosurg Spine. 2007;  6 298-303
• 32 Chiba K, Ogawa Y, Ishii K. Long-term results of expansive Open-door laminoplasty for cervical myelopathy – average 14-year follow-up study.  Spine. 2006;  31 2998-3005
• 33 Liu G, Buchowski J M, Bunmaprasert T et al. Revision surgery following cervical laminoplasty. Etiology and treatment strategies.  Spine. 2009;  34 2760-2768
• 34 Ratliff J K, Cooper P R. Cervical laminoplasty: a critical review.  J Neurosurg. 2003;  98 (Suppl. Spine) 230-238
• 35 Chang U K, Kim D H, Lee M C et al. Changes in adjacent-level disk pressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion.  J Neurosurg Spine. 2007;  7 33-39
• 36 Reitman C A, Hipp J A, Nguyen K et al. Changes in segmental intervertebral motion adjacent to cervical arthrodesis: a prospective study.  Spine. 2004;  29 2832-2843
• 37 Hilibrand A S, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion.  Spine J. 2004;  4 190S-194S
• 38 Greiner-Perth R, Allam Y, El-Saghir H et al. Analysis of reoperations after surgical treatment of degenerative cervical spine disorders: A report on 900 cases.  Cent eur Neurosurg. 2009;  70 3-8
• 39 McCormick P C. Editorial – the adjacent segment.  J Neurosurg Spine. 2007;  6 1-4
• 40 Wang M C, Kreuter W, Wolfla C E et al. Trends and variations in cervical spine surgery in the United States: Medicare beneficiaries, 1992 to 2005.  Spine. 2009;  34 955-961
• 41 King J T, Abbed K, Could G C et al. Cervical spine reoperation rates and hospital resource utilization after initial surgery for degenerative cervical spine disease in 12 338 patients in Washington State.  J Neurosurg Spine. 2009;  65 1011-1013
• 42 Wang M C, Chan L, Maiman D J et al. Complications and mortality associated with cervical spine surgery for degenerative disease in the United States.  Spine. 2007;  32 342-347
• 43 Shamji M F, Cook C, Pietrobon R. Impact of surgical approach on complications and resource utilization of cervical spine fusion: a nationwide perspective to the surgical treatment of diffuse cervical spondylosis.  The Spine. J ;  9 51-58
• 44 Carrage E J, Bono C M, Scuderi G J. Pseudomorbidity in iliac crest bone graft harvesting: the rise of rhBMP-2 in short-segment posterior lumbar fusion.  The Spine J. 2009;  9 873-879
• 45 Shamsaldin M, Mouchaty H, Desogus N et al. Evaluation of donor site pain after anterior iliac crest harvesting for cervical fusion: a prospective study on 50 patients.  Acta Neurochirur (Wien). 2006;  148 1071-1074
• 46 Hannallah D, Lee L, Kahn M et al. Cerebrospinal fluid leaks following cervical spine surgery.  J Bone Joint Surg. 2008;  90-A 1101-1105
• 47 Takemitsu M, Cheung K M, Wong Y W et al. C5 nerve root palsy after cervical laminoplasty and posterior fusion with instrumentation.  J Spine Disord Tech. 2008;  21 267-272
• 48 Hasegawa K, Homma T, Chiba Y. Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion.  Spine. 2007;  32 E197-E202
• 49 Imagama S, Mastuyama Y, Yukawa Y. C5 palsy after cervical laminoplasty. A multicenter study.  J Bone Joint Surg. 2010;  92-B 393-400
• 50 Fountas K N, Kapsalaki E Z, Nikolakakos L G. Anterior cervical discectomy and fusion associated complications.  Spine. 2007;  32 2310-2317
• 51 Lee M J, Bazaz R, Furey C G et al. Risk factors for dysphagia after anterior cervical spine surgery: a two-year prospective cohort study.  The Spine J. 2007;  7 141-147
• 52 Campbell M J, Carreon L Y, Traynelis V et al. Use of cervical collar after single-level anterior cervical fusion with plate. Is it necessary?.  Spine. 2008;  34 43-48
• 53 Peolsson A, Peolsson M. Predictive factors for long-term outcome of anterior cervical decompression and fusion: a multivariate data analysis.  Eur Spine J. 2008;  17 406-414