Verletzungen der subaxialen Halswirbelsäule

Zusammenfassung

Die untere Halswirbelsäule (HWS) ist anfällig für Verletzungen, die 2,5–5% aller knöchernen Verletzungen ausmachen. Statistiken zeigen, dass 20–50% aller Wirbelsäulenverletzungen die HWS betreffen, wobei 50–70% auf die untere HWS entfallen. In Deutschland gab es 2018 rund 11.528 stationäre Behandlungen aufgrund von Halswirbelsäulenfrakturen, mit steigender Tendenz.

Rückenmarkverletzungen bei HWS-Verletzungen treten mit etwa 10–12% auf, wobei das Risiko im Vergleich zu Brust- und Lendenwirbelverletzungen dreifach höher ist. Sportliche Aktivitäten, Verkehrsbeteiligung und Stürze über 2 m Höhe erhöhen das Risiko signifikant.

Begleitverletzungen sind in bis zu 80% der Fälle vorhanden und betreffen andere Wirbelsäulenabschnitte, Schädel-Hirn-Trauma und Extremitäten. Die Segmente C5–6 und C6–7 sind am häufigsten betroffen.

Die AO Spine-Klassifikation für subaxiale HWS-Verletzungen, eingeführt 2015, berücksichtigt Facettenverletzungen und neurologischen Status. Diagnostisch ist die Canadian-C-Spine-Rule relevant, während die CT für die primäre HWS-Bildgebung bevorzugt wird.

Therapieoptionen umfassen konservative Ansätze für nicht dislozierte Frakturen, während operative Eingriffe, ventral oder dorsal, bei instabilen Verletzungen erforderlich sind. Die Wahl der Therapie hängt von verschiedenen Faktoren ab, darunter die Art der Verletzung und der neurologische Status.

Die Prognose nach HWS-Verletzungen variiert je nach Grad der neurologischen Beteiligung. Ohne Rückenmarkverletzung erzielen die meisten Patienten gute Ergebnisse, während Rückenmarkverletzungen die Lebensqualität negativ beeinflussen. Die Rückkehr in den Beruf gelingt in vielen Fällen, und radikuläre Läsionen heilen häufig symptomfrei aus. Relevante Nackenschmerzen sind jedoch in etwa 20% der Fälle nach 2,5 Jahren zu verzeichnen.

Abstract

The lower cervical spine is susceptible to injuries, constituting 2.5–5% of all bony injuries. Statistics reveal that 20–50% of all spinal injuries involve the cervical spine, with 50–70% affecting the lower cervical spine. In Germany, there were approximately 11,528 inpatient treatments for cervical spine fractures in 2018, with an increasing trend.

Spinal cord injuries in cervical spine injuries occur at about 10–12%, with the risk being three times higher compared to thoracic and lumbar spine injuries. Sports activities, participation in traffic, and falls from heights over 2 meters significantly increase the risk.

Associated injuries are present in up to 80% of cases and affect other spinal segments, skull-brain trauma, and extremities. Segments C5–6 and C6–7 are most commonly affected.

The AO Spine classification for subaxial cervical spine injuries, introduced in 2015, considers facet injuries and neurological status. Diagnostically, the Canadian C-Spine Rule is relevant, while CT is preferred for primary cervical spine imaging.

Therapeutic options include conservative approaches for non-dislocated fractures, while operative interventions, either ventral or dorsal, are necessary for unstable injuries. The choice of therapy depends on various factors, including the type of injury and neurological status.

The prognosis after cervical spine injuries varies based on the degree of neurological involvement. Without spinal cord injury, most patients achieve good results, while spinal cord injuries negatively impact quality of life. Returning to work is successful in many cases, and radicular lesions often heal symptom-free. However, relevant neck pain is observed in approximately 20% of cases after 2.5 years.

Schlüsselwörter

subaxiale HWS - Verletzung - Trauma - Facettengelenk - Luxationsfraktur

Keywords

subaxial cervical spine - injury - trauma - facet joint - fracture dislocation

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