Komplikationsanalyse von spinalen Eingriffen bei adulten zentralen Bewegungsstörungen und Skoliosen

Zusammenfassung

Hintergrund: Adulte, zentral bedingte Bewegungsstörungen, Fehlhaltungen und Skoliosen können auf verschiedene neurologische Grunderkrankungen wie den Morbus Parkinson, das Pisa-Syndrom oder die segmentale Dystonie zurückzuführen sein. Wichtige klinische Merkmale sind auffallende Fehlhaltungen wie Kamptokormie („bent spine“) oder ein Laterocollis. Die operative Versorgung der Wirbelsäule bei adulten neuromuskulären Skoliosen und Fehlhaltungen stellt hohe Ansprüche an den Chirurgen. Insbesondere die Dekompensation des sagittalen Alignments stellt ein zentrales Problem dar. Der Morbus Parkinson ist mit erheblichen operationsspezifischen und allgemeinen Komplikationen assoziiert. Das Pisa-Syndrom ist eine Entität, die primär einer medikamentösen Therapie bedarf. Ziel der Arbeit ist eine Analyse von Komplikationen bei spinalen Eingriffen in diesem speziellen Patientenkollektiv. Patienten/Material und Methoden: Eine Fallserie mit 10 Kasuistiken operativ behandelter Patienten mit Morbus Parkinson und Pisa-Syndrom wird vorgestellt und diskutiert. Daraus leiten sich Behandlungsempfehlungen ab, die mit einer Übersicht aus der Literatur ergänzt werden. Ergebnisse und Schlussfolgerung: Bereits minimalinvasive, operative Eingriffe bei Patienten mit Morbus Parkinson können zu Instabilitäten von ganzen Abschnitten der Wirbelsäule und zur Dekompensation des sagittalen Alignments führen. Implantatlockerung, Anschlussinstabilität, allgemeine perioperative Komplikationen und progrediente Fehlhaltung durch Krankheitsprogress können katastrophale Behandlungsverläufe nach sich ziehen. Bei notwendigen Instrumentierungen sollte langstreckigen Verfahren mit ventraler Abstützung der Vorzug gegeben werden. In diesem Patientenklientel sollte bei Osteoporose immer die Pedikelschrauben-Zementaugmentation in Erwägung gezogen werden. Essenziell ist eine optimale präoperative Behandlung der Patienten durch fachneurologische Vorbereitung. Die Diagnose Pisa-Syndrom erfordert ebenfalls eine optimierte präoperative Vorbereitung mit fachneurologischer Unterstützung. In vielen Fällen kann sogar eine operative Intervention durch eine medikamentöse Therapie vermieden werden.

Abstract

Background: Adult central movement disorders, malpostures, and scolioses can have their cause in various neurological underlying diseases such as Morbus Parkinson, Pisa syndrome, or segmental dystonia. Important clinical characteristics are marked postural distortions such as camptocormia (bent spine) or laterocollis. In cases of these adult scolioses, surgical spine treatment puts high demands on the surgeon. Surgery in Parkinsonʼs disease, for example, is associated with serious surgery-specific as well as general complications. The more rarely occurring Pisa syndrome is an entity primarily requiring medical therapy. Patients and Methods: A series of ten case reports of patients with Morbus Parkinson and Pisa syndrome who underwent spinal surgery is presented and discussed. From these reports, treatment recommendations have been derived and complemented by references from the literature. An extensive MEDLINE search was performed for this purpose. Results and Conclusion: In patients suffering from Parkinsonʼs disease, even minor surgical interventions can lead to instability of whole spine segments or even the entire spine. Implant loosening, adjacent segment instability, general perioperative complications, and progressive malposture due to disease progress can bring forth disastrous treatment courses. Spinal fixation should be performed long-segmented in combination with ventral stabilisation. Due to osteoporosis, pedicle screw cement augmentation is recommended in this collective. If the diagnosis of Pisa syndrome is established, an optimised preoperative preparation should be initiated in close cooperation with neurologists. In many cases medical therapy is sufficient and surgical interventions can be avoided.

Schlüsselwörter

zentrale Bewegungsstörungen - Laterocollis - Kamptokormie - Pisa-Syndrom - Morbus Parkinson

Key words

central movement disorders - laterocollis - camptocormia - Pisa syndrome - Parkinsonʼs disease

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