Luxationsfrakturen der unteren HWS – dorsal beginnen!

Abstract

Luxationsfrakturen der unteren HWS – also ab Hw3 abwärts – sind komplexe und meist hoch instabile Verletzungen, die einer operativen Therapie bedürfen. In diesem Pro/Kontra-Beitrag werden diese Verletzungen zunächst in die Systematik der AO-Spine Klassifikation eingeordnet, die adäquate Diagnostik erläutert und die Behandlungsziele definiert. Nach Vorstellung der grundsätzlichen Therapieoptionen werden die Bedingungen dargelegt, die für ein primär dorsales Vorgehen sprechen: (1) eine dorsal des Myelons gelegene traumatische Raumforderung oder die Notwendigkeit zur mehrsegmentalen Dekompression, (2) eine traumatische Foramenstenose, (3) eine ankylosierende Grunderkrankung oder (4) eine verminderte Knochendichte.

Abstract

Fracture dislocations of the subaxial cervical spine are complex and mostly highly instable injuries requiring surgical therapy. This pro/con article categorizes these injuries according to the AOSpine classification system, explains adequate diagnostics, and defines treatment goals. After presentation of the principle therapeutic options, conditions speaking in favor of a POSTERIOR-FIRST-strategy are elaborated: (1) a traumatic space-occupying lesion posterior to the myelon or the need for multisegmental decompression, (2) traumatic foraminal stenosis, (3) ankylosing disease of the spine or (4) reduced bone mineral density.

Schlüsselwörter

HWS-Verletzung - operativer Zugang - Fraktur, Luxation - Wirbelsäule - subaxial

Keywords

cervical trauma - surgical approach - fracture, dislocation - spine - subaxial

• Literatur

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