Knochentumoren der Wirbelsäule

Zusammenfassung

Primäre Knochentumoren der Wirbelsäule stellen eine Seltenheit dar. Aus diesem Grund ist es wichtig, dass der Wirbelsäulenchirurg frühzeitig die klinischen Zeichen deutet und darüber hinaus die richtigen Untersuchungen sowohl in der Klinik als auch in der Bildgebung einleitet, so dass eine adäquate Therapie frühzeitig beginnen kann. Die unspezifischen Rückenschmerzen der Patienten erklären die lange Zeit zwischen Initialsymptomen und definitiver Erstdiagnose. Neben der konventionellen Röntgenaufnahme spielen CT und MRT eine wichtige Rolle in der diagnostischen Bildgebung der Knochentumoren. Schlussendlich wird die Verdachtsdiagnose durch eine Biopsie erhärtet. Die „häufigsten seltenen” gutartigen Vertreter der primären Knochentumoren an der Wirbelsäule sind das Osteoidosteom, das Osteoblastom, das Osteo-chondrom, das Hämangiom, die aneurysmatische Knochenzyste und das eosinophile Granulom. Je nach Rezidivfreudigkeit und Aggressivität des Tumors sollte entsprechend eine intraläsionale Kürettage oder eine marginale Enbloc-Resektion angestrebt werden. Da letztere antomisch nicht immer möglich ist sollten Strahlen-und Chemotherapie assistiv berücksichtigt werden. Hauptvertreter der bösartigen Tumoren sind das multiple Myelom, das Plasmozytom, das Ewing-Sarkom, das Osteosarkom, das Chordom und das Chondrosarkom. Eine marginale oder weite En-bloc-Resektion sollte angestrebt werden, wobei die Einführung der neoadjuvanten Chemotherapie neue Möglichkeiten eröffnet hat.

Summary

Primary tumours of the vertebral column are uncommon. Early diagnosis leads to early initiation of tumor treatment. Thus, clinical examination and diagnostic imaging play an important role as treatment tools in the hands of spine surgeons. The nondescript back pain explain the time delay from symptom onset to final diagnosis and tumour exstirpation. CT and MRI scans complete conventional radiography. The role of biopsy on the way to final diagnosis should not be underestimated. Benign primary vertebral column neoplasms such as osteoid osteoma, osteoblastoma, osteochondroma, hemangioma, aneurysmatic bone cysts and eosinophilic granuloma are the most common representatives. Internal curettage is an appropriate surgical strategy for benign tumors only when the lesion is well contained within bone and has little propensity for recurrence. Given the anatomic constraints of the vertebral column radio-therapy and chemotherapy should be taken into consideration when marginal excision is needed but is not possible. Primary malignant tumors of the vertebral column such as multiple myeloma, plasmacytoma, Ewing´s sarcoma, osteosarcoma, chordoma and chondrosarcoma should be treated with marginal or wide en-bloc excision if possible, whereas the implementation of neoadjuvant chemotherapy had an immense impact on prognosis, at least for osteosarcoma and Ewing´s sarcoma.

Schlüsselwörter

Knochentumor - Wirbelsäule - Osteoidosteom - Osteoblastom - Osteochondrom - Hämangiom - aneurysmatische Knochenzyste - eosinophile Granulom

Keywords

Bone tumour - vertebral column - osteoid osteoma - osteoblastoma - osteochondroma - hemangioma - aneurysmatic bone cysts - eosinophilic granuloma

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