PDF herunterladen
Z Orthop Unfall 2007; 145(5): 655-673
DOI: 10.1055/s-2007-965759
Refresher Orthopädie und Unfallchirurgie

© Georg Thieme Verlag KG Stuttgart · New York

Operative Therapie der rheumatischen Halswirbelsäule

F. Kerschbaumer1 , G. Y. Kerschbaumer1 , F. Kandziora2
  • 1Klinik Rotes Kreuz, Frankfurt am Main
  • 2Klinik für Chirurgie des Bewegungsapparates, Charité, Berlin
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
15. Oktober 2007 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Einleitung

Die Kenntnis der HWS-Pathologie und deren Folgen im Rahmen rheumatischer Erkrankungen ist essenziell, da unter bestimmten Voraussetzungen nicht nur Wohlergehen und Gesundheit, sondern auch das Leben unserer Patienten zur Disposition steht. Mit modernen Biologika wie TNF-alpha oder IL-Antagonisten sind zwar schwere, mutilierende Erkrankungsformen nicht mehr so häufig, aber dennoch bleibt die latente Gefahr einer potenziell lebensbedrohenden Instabilität weiter aufrecht.

Während bei der rheumatoiden Arthritis (RA) die Instabilität das Hauptproblem darstellt, stehen bei den mit HLA‐B27 assoziierten Spondarthritiden die Deformitäten und pathologischen Frakturen im Vordergrund.

Literatur

  • 1 Aggarwal A. et al . Cervical spine involvement in rheumatoid arthritis: prevalence and relationship with overall disease severity.  J Assoc Physicians India. 1996;  44 468-471
    PubMedSuche in Google Scholar
  • 2 Boden S D. Rheumatoid arthritis of the cervical spine. Surgical decision making based on predictors of paralysis and recovery.  Spine. 1994;  19 2275-2280
    PubMedSuche in Google Scholar
  • 3 Boden S D. et al . Rheumatoid arthritis of the cervical spine. A long-term analysis with predictors of paralysis and recovery.  J Bone Joint Surg Am. 1993;  75 1282-1297
    PubMedSuche in Google Scholar
  • 4 Brattström H, Granholm L. Chirurgie der Halswirbelsäule bei Patienten mit rheumatoider Arthritis.  Orthopädie. 1973;  2 118-120
    PubMedSuche in Google Scholar
  • 5 Brattström H, Granholm L. Atlanto-axial fusion in rheumatoid arthritis. A new method of fixation with wire and bone cement.  Acta Orthop Scand. 1976;  47 619-628
    PubMedSuche in Google Scholar
  • 6 Brooks A L, Jenkins E B. Atlanto-axial arthrodesis by the wedge compression method.  J Bone Joint Surg Am. 1978;  60 279-284
    CrossrefPubMedSuche in Google Scholar
  • 7 Casey A T, Crockard H A. Vital reconstruction in rheumatoid arthritis. Baumgartner H et al. Rheumatoid Arthritis: Current Trends in Diagnostics, Conservative Treatment and Surgical Reconstruction. Stuttgart; Thieme 1995
    Suche in Google Scholar
  • 8 Casey A T. et al . Surgery on the rheumatoid cervical spine for the non-ambulant myelopathic patient - too much, too late?.  Lancet. 1996;  347 1004-1007
    CrossrefPubMedSuche in Google Scholar
  • 9 Castro S. et al . Cervical spine involvement in rheumatoid arthritis: a clinical, neurological and radiological evaluation.  Clin Exp Rheumatol. 1994;  12 369-374
    PubMedSuche in Google Scholar
  • 10 Cohen C. Fatal dislocation of cervical spine in rheumatoid disease.  Gerontol Clin (Basel). 1969;  11 239-243
    PubMedSuche in Google Scholar
  • 11 Conlon P W, Isdale I C, Rose B S. Rheumatoid arthritis of the cervical spine. An analysis of 333 cases.  Ann Rheum Dis. 1966;  25 120-126
    PubMedSuche in Google Scholar
  • 12 Crockard H A. et al . Transoral decompression and posterior fusion for rheumatoid atlanto-axial subluxation.  J Bone Joint Surg Br. 1986;  68 350-356
    PubMedSuche in Google Scholar
  • 14 Dirheimer Y. The craniovertebral region in chronic inflammatory rheumatic diseases. Berlin; Springer 1977
    Suche in Google Scholar
  • 15 Frankel H L. et al . The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I.  Paraplegia. 1969;  7 179-192
    PubMedSuche in Google Scholar
  • 16 Gallie W E. Fractures and dislocation of the cervical spine.  Am J Surg. 1939;  46 495-499
    CrossrefPubMedSuche in Google Scholar
  • 17 Giner A, Kerschbaumer F, Bauer R. Spondylarthritis rheumatica der HWS. Prävalenz und operative Therapie.  Z Rheuma. 1983;  43 4
    PubMedSuche in Google Scholar
  • 18 Grob D. et al . Posterior occipito-cervical fusion in rheumatoid arthritis.  Arch Orthop Trauma Surg. 1990;  110 38-44
    PubMedSuche in Google Scholar
  • 19 Grob D. et al . Atlanto-axial fusion with transarticular screw fixation.  J Bone Joint Surg Br. 1991;  73 972-976
    CrossrefPubMedSuche in Google Scholar
  • 20 Grob D, Magerl F. Surgical stabilization of C1 and C2 fractures.  Orthopade. 1987;  16 46-54
    PubMedSuche in Google Scholar
  • 21 Gschwend N, Scheier M, Munzinger U. Entzündliche Veränderungen der Wirbelsäule bei chronischer Polyarthritis.  Orthopädie. 1981;  10 155-168
    PubMedSuche in Google Scholar
  • 22 Hanley Jr E N, Harvell Jr J C. Immediate postoperative stability of the atlantoaxial articulation: a biomechanical study comparing simple midline wiring, and the Gallie and Brooks procedures.  J Spinal Disord. 1992;  5 306-310
    PubMedSuche in Google Scholar
  • 23 Harms J, Schmelzle R, Stoltze D. Osteosynthesen im occipito-cervicalen Übergang vom transoralen Zugang aus. München; Demeter 1987
    Suche in Google Scholar
  • 24 Heywood A W, Learmonth I D, Thomas M. Cervical spine instability in rheumatoid arthritis.  J Bone Joint Surg Br. 1988;  70 702-707
    PubMedSuche in Google Scholar
  • 25 Ho E K, Leong J C. Traumatic tetraparesis: a rare neurologic complication in ankylosing spondylitis with ossification of posterior longitudinal ligament of the cervical spine. A case report.  Spine. 1987;  12 403-405
    CrossrefPubMedSuche in Google Scholar
  • 26 Isdale I C, Conlon P W. Atlanto-axial subluxation. A six-year follow-up report.  Ann Rheum Dis. 1971;  30 387-389
    PubMedSuche in Google Scholar
  • 27 Isdale I C, Corrigan A B. Backward luxation of the atlas. Two cases of an uncommon condition.  Ann Rheum Dis. 1970;  29 6-9
    PubMedSuche in Google Scholar
  • 28 Jones M W, Kaufmann J C. Vertebrobasilar artery insufficiency in rheumatoid atlantoaxial subluxation.  J Neurol Neurosurg Psychiatry. 1976;  39 122-128
    PubMedSuche in Google Scholar
  • 29 Kandziora F. et al . Biomechanical assessment of transoral plate fixation for atlantoaxial instability.  Spine. 2000;  25 1555-1561
    CrossrefPubMedSuche in Google Scholar
  • 30 Kandziora F, Mittlmeier T, Kerschbaumer F. Stage-related surgery for cervical spine instability in rheumatoid arthritis.  Eur Spine J. 1999;  8 371-381
    CrossrefPubMedSuche in Google Scholar
  • 31 Kauppi M, Hakala M. Prevalence of cervical spine subluxations and dislocations in a community-based rheumatoid arthritis population.  Scand J Rheumatol. 1994;  23 133-136
    CrossrefPubMedSuche in Google Scholar
  • 32 Kerschbaumer F. Rheumatische Instabilität der Halswirbelsäule. Bauer, Kerschbaumer, Poisel Orthopädische Operationslehre Bd. 1. Stuttgart; Georg Thieme 1991
    Suche in Google Scholar
  • 33 Kerschbaumer F. et al . Transoral decompression, anterior plate fixation, and posterior wire fusion for irreducible atlantoaxial kyphosis in rheumatoid arthritis.  Spine. 2000;  25 2708-2715
    PubMedSuche in Google Scholar
  • 34 Kerschbaumer F. et al . Die atlantoaxiale Kyphose.  Orthopäde. 2001;  30 919-924
    CrossrefPubMedSuche in Google Scholar
  • 35 Koh W H, Garrett S L, Calin A. Cervical spine surgery in ankylosing spondylitis: is the outcome good?.  Clin Rheumatol. 1997;  16 466-470
    CrossrefPubMedSuche in Google Scholar
  • 36 Kraus D R. et al . Incidence of subaxial subluxation in patients with generalized rheumatoid arthritis who have had previous occipital cervical fusions.  Spine. 1991;  16 S486-489
    PubMedSuche in Google Scholar
  • 37 Kudo H, Iwano K. Surgical treatment of subaxial cervical myelopathy in rheumatoid arthritis.  J Bone Joint Surg Br. 1991;  73 474-480
    PubMedSuche in Google Scholar
  • 38 Magerl F, Seemann P. Stable posterior fusion of the atlas and the axis by transarticular screw fixation. Kehr P, Weidern A Cervical spine. Wien, New York; Springer 1986: 322-327
    Suche in Google Scholar
  • 39 Malcolm G P, Ransford A, Crockard H A. Treatment of non-rheumatoid occipitocervical instability. Internal fixation with the Hartshill-Ransford loop.  J Bone Joint Surg Br. 1994;  76 357-366
    PubMedSuche in Google Scholar
  • 40 Martel W. The occipito-atlanto-axial joints in rheumatoid arthritis and ankylosing spondylitis.  Am J Roentgenol Radium Ther Nucl Med. 1961;  86 223-240
    PubMedSuche in Google Scholar
  • 41 McMaster M J. Osteotomy of the cervical spine in ankylosing spondylitis.  J Bone Joint Surg Br. 1997;  79 197-203
    CrossrefPubMedSuche in Google Scholar
  • 42 Meikle J A, Wilkinson M. Rheumatoid involvement of the cervical spine. Radiological assessment.  Ann Rheum Dis. 1971;  30 154-161
    PubMedSuche in Google Scholar
  • 43 Mikulowski P. et al . Sudden death in rheumatoid arthritis with atlanto-axial dislocation.  Acta Med Scand. 1975;  198 445-451
    CrossrefPubMedSuche in Google Scholar
  • 44 Miller F H, Rogers L. Fractures of the dens complicating ankylosing spondylitis with atlantooccipital fusion.  J Rheumatol. 1991;  18 771-774
    PubMedSuche in Google Scholar
  • 45 Neva M H. et al . Combination drug therapy retards the development of rheumatoid atlantoaxial subluxations.  Arthritis Rheum. 2000;  43 2397-2401
    CrossrefPubMedSuche in Google Scholar
  • 46 Nurick S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis.  Brain. 1972;  95 87-100
    CrossrefPubMedSuche in Google Scholar
  • 47 Olerud C, Frost A, Bring J. Spinal fractures in patients with ankylosing spondylitis.  Eur Spine J. 1996;  5 51-55
    CrossrefPubMedSuche in Google Scholar
  • 48 Olerud C, Larsson B E, Rodriguez M. Subaxial cervical spine subluxation in rheumatoid arthritis. A retrospective analysis of 16 operated patients after 1 - 5 years.  Acta Orthop Scand. 1997;  68 109-115
    PubMedSuche in Google Scholar
  • 49 Peh W C, Ho E K. Fracture of the odontoid peg in ankylosing spondylitis: case report.  J Trauma. 1995;  38 361-363
    PubMedSuche in Google Scholar
  • 50 Peppelman W C. et al . Cervical spine surgery in rheumatoid arthritis: improvement of neurologic deficit after cervical spine fusion.  Spine. 1993;  18 2375-2379
    PubMedSuche in Google Scholar
  • 51 Ramos-Remus C. et al . Frequency of atlantoaxial subluxation and neurologic involvement in patients with ankylosing spondylitis.  J Rheumatol. 1995;  22 2120-2125
    PubMedSuche in Google Scholar
  • 52 Ranawat C S. et al . Cervical spine fusion in rheumatoid arthritis.  J Bone Joint Surg Am. 1979;  61 1003-1010
    PubMedSuche in Google Scholar
  • 53 Ransford A O. et al . Craniocervical instability treated by contoured loop fixation.  J Bone Joint Surg Br. 1986;  68 173-177
    PubMedSuche in Google Scholar
  • 54 Roca A, Bernreuter W K, Alarcon G S. Functional magnetic resonance imaging should be included in the evaluation the cervical spine in patients with rheumatoid arthritis.  J Rheumatol. 1993;  20 1485-1488
    PubMedSuche in Google Scholar
  • 55 Rowed D W. Management of cervical spinal cord injury in ankylosing spondylitis: the intervertebral disc as a cause of cord compression.  J Neurosurg. 1992;  77 241-246
    PubMedSuche in Google Scholar
  • 56 Santavirta S. et al . Ten-year results of operations for rheumatoid cervical spine disorders.  J Bone Joint Surg Br. 1991;  73 116-120
    PubMedSuche in Google Scholar
  • 57 Santavirta S. et al . Operations for the unstable cervical spine in rheumatoid arthritis. Sixteen cases of subaxial subluxation.  Acta Orthop Scand. 1990;  61 106-110
    PubMedSuche in Google Scholar
  • 58 Santavirta S. et al . Atlanto-axial subluxation in patients with seronegative spondylarthritis.  Rheumatol Int. 1987;  7 43-46
    CrossrefPubMedSuche in Google Scholar
  • 59 Savini R, Di Silvestre M, Gargiulo G. Cervical osteotomy by the Simmons method in the treatment of cervical kyphosis due to ankylosing spondylitis. Case report.  Ital J Orthop Traumatol. 1988;  14 377-383
    PubMedSuche in Google Scholar
  • 60 Shimizu K. et al . Correction of kyphotic deformity of the cervical spine in ankylosing spondylitis using general anesthesia and internal fixation.  J Spinal Disord. 1996;  9 540-543
    PubMedSuche in Google Scholar
  • 61 Simmons E H, Bradley D D. Neuro-myopathic flexion deformities of the cervical spine.  Spine. 1988;  13 756-762
    CrossrefPubMedSuche in Google Scholar
  • 62 Thabe H. Atlanto-dentoid dislocation in chronic polyarthritis. Correlation of clinical, roentgenological, neurological and electromyographical findings.  Z Rheumatol. 1981;  40 6-11
    PubMedSuche in Google Scholar
  • 63 Urist M R. Osteotomy of the cervical spine; report of a case of ankylosing rheumatoid spondylitis.  J Bone Joint Surg Am. 1958;  40-A 833-843
    PubMedSuche in Google Scholar
  • 64 Webb F W, Hickman J A, Brew D S. Death from vertebral artery thrombosis in rheumatoid arthritis.  Br Med J. 1968;  2 537-538
    PubMedSuche in Google Scholar
  • 65 Werne S. Studies in spontaneous atlas dislocation.  Acta Orthop Scand Suppl. 1957;  23 1-150
    PubMedSuche in Google Scholar
  • 66 Werne S. The possibilities of movement in the craniovertebral joints.  Acta Orthop Scand. 1959;  28 165-173
    PubMedSuche in Google Scholar
  • 67 Yonezawa T. et al . Subaxial lesions in rheumatoid arthritis. Radiographic factors suggestive of lower cervical myelopathy.  Spine. 1995;  20 208-215
    PubMedSuche in Google Scholar
  • 68 Zygmunt S C. et al . Realignment and surgical fixation of atlanto-axial and subaxial dislocations in rheumatoid arthritis (RA) patients.  Acta Neurochir Suppl (Wien). 1988;  43 79-84
    PubMedSuche in Google Scholar

Prof. Dr. F. Kerschbaumer

Klinik Rotes Kreuz

Königswarterstr. 16
60316 Frankfurt am Main

eMail: f_kerschbaumer@yahoo.com