Central Cord Syndrome nach Sturz bei Stenose: Nicht operieren!

Zusammenfassung

Das Central Cord Syndrome (CCS) ist definiert durch eine armbetonte motorische Schädigung, eine Blasenentleerungsstörung, sowie ein wechselhaftes sensibles Defizit kaudal der Läsion. Das CCS ist zudem die häufigste akute inkomplette zervikale Rückenmarksschädigung. Typischerweise sind ältere Patienten mit einer vorbestehenden spondylogenen zervikalen Stenose und einem akuten Hyperextensionstrauma betroffen. Historisch galt über viele Jahre die konservative Behandlung als einzig sinnvolle Therapieoption. In der jüngeren Vergangenheit hat sich ein deutlicher Trend zur operativen Therapie des CCS entwickelt. Die Indikation zur OP ist abhängig vom Ausmaß der neurologischen Schädigung und dem bildgebenden Befund. Der Nachweis von intramedullären Signalhyperintensitäten in den T2-Gewichtungen des MRT oder einer segmentalen Instabilität gelten als Prädiktoren für eine schlechtere neurologische Erholung. Viele Patienten mit einem akuten CSS weisen nur eine geringfügige neurologische Beeinträchtigung auf (ASIA Grad D). Hier ist ein abwartendes Verhalten mit neurologischer Verlaufsbeobachtung zu empfehlen. Im Falle einer ausbleibenden neurologischen Verbesserung entsteht den Patienten durch einen späteren operativen Eingriff kein Nachteil. In vielen Fällen kann den oftmals älteren Patienten eine unnötige Operation damit erspart werden.

Abstract

The central cord syndrome (CCS) is characterized by greater weakness in the upper versus the lower extremities, bladder dysfunction and variable sensory loss. It represents the most common type of acute incomplete spinal cord injury. CCS typically occurs in older patients with preexisting spinal stenosis who sustain a hyperextension injury to the neck. Historically, the initial treatment of the CCS was almost always conservative. In the recent past there is a strong trend towards operative treatment. Indication for surgery depends on the extent of the neurologic deficit and the diagnostic findings in the radiological evaluation. The presence of intramedullary T2 signal intensity or segmental instability is considered as a predictor for poor neurological outcome. Most patients with an acute CCS show only minor neurological deficits (ASIA Grade D). In this case an observational course with neurological monitoring is recommended. If the neurological status reaches a plateau that is unsatisfactory for the patient surgical treatment is still an option. The delay in surgical timing does not affect the postoperative outcome. Thereby an unnecessary operation can be avoided in many elderly patients.

Schlüsselwörter

Central cord syndrome - Halswirbelsäule - zervikale Stenose - konservative Therapie

Keywords

cervical cord syndrome - cervical spine - cervical spinal stenosis - conservative treatment

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