Der zervikale Bandscheibenvorfall

K. J. Schnake; C.-H. Hoffmann; F. Kandziora

doi:10.1055/s-0032-1328067

Zeitschrift für Orthopädie und Unfallchirurgie, Table of Contents

Z Orthop Unfall 2012; 150(6): 657-673
DOI: 10.1055/s-0032-1328067

Refresher Orthopädie und Unfallchirurgie

Georg Thieme Verlag KG Stuttgart · New York

Der zervikale Bandscheibenvorfall

Cervical Disc Herniation

K. J. Schnake

¹Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie der BG Unfallklinik Frankfurt am Main

,

C.-H. Hoffmann

¹Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie der BG Unfallklinik Frankfurt am Main

,

F. Kandziora

¹Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie der BG Unfallklinik Frankfurt am Main

› Author Affiliations

Abstract

Zusammenfassung

Der zervikale Bandscheibenvorfall ist durch einen Austritt von Gewebe des Nucleus pulposus durch den Anulus fibrosus in den Spinalkanal gekennzeichnet. Dort führt die mechanische oder chemische Irritation neuraler Strukturen zu Symptomen einer Radikulopathie, Zervikozephalgie oder Myelopathie. Ausgeprägte sensomotorische Defizite oder konservativ nicht zu beherrschende Schmerzen stellen eine Operationsindikation dar. Ansonsten ist die Therapie des zervikalen Bandscheibenvorfalls konservativ mittels Analgetika, aktiver und passiver Physiotherapie und lokalen Infiltrationen. Die anteriore zervikale Diskektomie und Fusion (ACDF) stellt das operative Standardverfahren dar. Es werden überwiegend Cages mit oder ohne additive Platten verwendet. Alternativ besteht die Möglichkeit der Implantation einer Bandscheibenprothese, sofern keine Kontraindikationen vorliegen. Andere chirurgische Techniken können in geeigneten Fällen ebenfalls angewandt werden. Die klinischen und radiologischen Ergebnisse operativer und konservativer Maßnahmen sind insgesamt als gut zu bezeichnen.

Abstract

The cervical disc herniation is characterized by prolapsed nucleus pulposus material through the annulus into the spinal canal. The local mechanical or chemical irritation of neural structures typically leads to symptoms of radiculopathy, cervicocephalgia or myelopathy. Pronounced sensorimotor deficits or intractable pain constitute surgical treatment. In all other cases conservative treatment is indicated, including pain medication, active and passive physiotherapy, and local injections, respectively. Anterior cervical discectomy and interbody fusion (ACDF) is still the surgical treatment of choice. Predominantly, cages with or without plates are in use to obtain solid fusion. The implantation of a total disc replacement is a viable alternative, if no contraindications exist. Other surgical techniques may be performed in proper selected cases. The overall clinical and radiological results of both surgical and conservative treatment are good.

Key words

zervikaler Bandscheibenvorfall - zervikale Radikulopathie - konservative Therapie - chirurgische Therapie

Key words

cervical disc herniation - cervical radiculopathy - conservative treatment - surgical treatment

Full Text

References

Literatur
1 Statistisches Bundesamt Wiesbaden. Diagnosedaten der Patientinnen und Patienten in Krankenhäusern für das Jahr 2010. https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Krankenhaeuser/DiagnosedatenKrankenhaus2120621107004.pdf?__blob=publicationFile S. 32; Stand: 05.12.2012
2 Jurek S, Rao RD. Cervical Spondylosis: Pathophysiology, natural History, and clinical Syndromes of Neck Pain, Radiculopathy, and Myelopathy. In: Herkowitz HN, Garfin SR, Eismont FJ, Bell GR, Balderston RA, eds.: Rothman-Simeone. The Spine. 6th ed. Philadelphia: Elsevier Saunders;; 2011. 36. 684-696
3 Ferguson RJ, Caplan LR. Cervical spondylotic myelopathy. Neurol Clin 1985; 3: 373-382
4 Mochida K, Komori H, Okawa A et al. Regression of cervical disk herniation observed on magnetic resonance images. Spine 1998; 23: 990-995
5 Arbeitsgemeinschaft der wissenschaftlichen medizinischen Fachgesellschaften. Nackenschmerzen. http://www.awmf.org/uploads/tx_szleitlinien/053-007_S3_Nackenschmerzen_Lang_06-2009_12-2014.pdf und: Zervikale Radikulopathie. http://www.awmf.org/uploads/tx_szleitlinien/030-082_S1_Radikulopathie__ zervikale_10-2008_10-2013.pdf Stand: 05.12.2012
6 Gross AR, Hoving JL, Haines TA et al. Cervical overview group. Spine 2004; 9: 1541-1548
7 WHO. Cancer, pain relief and palliative care. WHO technical report series no. 408. Geneva: World Health Organisation; 1990
8 Cyteval C, Thomas E, Decoux F et al. Cervical radiculopathy: open study on percutaneous, periradicular, foraminal steroid infiltration performed under CT control in patients. AJNR 2004; 25: 441-445
9 Slipman CW, Lipetz JS, Jackson HB et al. Therapeutic selective nerve root block in the neurosurgical treatment of atraumatic cervical spondylotic radicular pain: a retrospective analysis with independent clinical review. Arch Phys Med Rehabil 2000; 81: 741-746
10 Holland C, Jaeger L, Smentkowski U et al. Septic and aseptic complications of corticosteroid injections: an assessment of 278 cases reviewed by expert commissions and mediation boards from 2005 to 2009. Dtsch Arztebl Int 2012; 109: 425-430
11 Fehlings MG, Arvin B. Surgical management of cervical degenerative disease: the evidence related to indication, impact and outcome. J Neurosurg Spine 2009; 11: 97-100
12 Faldini C, Leonetti D, Nanni M et al. Cervical disc herniation and cervical spondylosis surgically treated by Cloward procedure: a 10-year-minimum follow-up study. J Orthopaed Traumatol 2010; 11: 99-103
13 Gebremariam L, Koes BW, Peul WC et al. Evaluation of treatment effectiveness for the herniated cervical disc: a systematic review. Spine 2012; 37: E109-E118
14 Cloward RB. The anterior approach for removal of ruptured cervical disc. J Neurosurg 1958; 15: 602-617
15 Smith AW, Robinson RA. Treatment of certain cervical spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 1958; 40: 607-624
16 Cabraja M, Koeppen D, Lanksch WR et al. Polymethylmetacrylate-assisted ventral discectomy: rate of pseudoarthrosis and clinical outcome with a minimum follow-up 5 years. BMJ Musculoskelet Disord 2011; 28: 12-14
17 Silber JS, Anderson DG, Daffner SD et al. Donor site morbidity after anterior iliac crest bone harvest for single level anterior cervical discectomy and fusion. Spine 2003; 28: 134-139
18 Mastronardi I, Ducati A, Ferrante I. Anterior cervical fusion with polyetheretherketone (PEEK) cages in the treatment of degenerative disc disease: Preliminary observations in 36 consecutive cases with a minimum 12-month follow-up. Acta Neurochir (Wien) 2006; 148: 307-312
19 Kulkarni AG, Hee HT, Wong HK. Solis cage (PEEK) for anterior cervical fusion: Preliminary radiological results with emphasis on fusion and subsidence. Spine 2007; 7: 205-209
20 Ryken TC, Heary RF, Matz PG et al. Techniques for cervical interbody grafting. J Neurosurg Spine 2009; 11: 203-220
21 Cabraja M, Oezdemir S, Koeppen D et al. Anterior cervical discectomy and fusion: Comparison of titanium and polyetheretherketone cages. BMC Musculoskelet Disord 2012; 13: 172
22 Niu CC, Liao JC, Chen WJ et al. Outcomes of interbody fusion cages used in 1 and 2-levels anterior cervical discectomy and fusion: titanium cages versus polyetheretherketone (PEEK) cages. J Spinal Disord Tech 2010; 23: 310-316
23 Gercek E, Arlet V, Delisie J et al. Subsidence of stand-alone cervical cages in anterior cervical interbody fusion: warning. Eur Spine J 2003; 12: 513-516
24 Schmieder K, Wolzik-Grossmann M, Pechlivanis I et al. Subsidence of the wing titanium cage after cervical interbody fusion: 2-years follow up. J Neurosurg Spine 2006; 4: 447-453
25 Vanek P, Bradac O, DeLacy P et al. Comparison of 3 fusion techniques in the treatment of degenerative cervical spine disease. Is stand-alone autograft really the “gold standard”?. Spine 2012; 37: 1645-1651
26 Song KJ, Taghavi CE, Hsu MS et al. Plate augmentation in cervical discectomy and fusion with cage for degenerative cervical spinal disorders. Eur Spine 2010; 19: 1677-1683
27 Fraser JF, Härtl R. Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine 2007; 6: 298-303
28 Lowery GI, McDonough RF. The significance of hardware failure in anterior cervical plate fixation. Patients with 2- to 7-year follow up. Spine 1998; 23: 181-186
29 Scholz M, Schnake KJ, Pingel A et al. A new zero-profile implant for stand-alone anterior cervical interbody fusion. Clin Orthop Rel Res 2011; 469: 666-673
30 Jacobs W, Willems PC, Kruyt M et al. Systematic review of anterior interbody fusion techniques for single and double level cervical degenerative disc disease. Cochrane collaboration. Spine 2011; 14: E950-E960
31 Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating: A 5- to 11-year radiologic and clinical follow-up study. Spine 2005; 30: 2138-2144
32 Goldberg EJ, Singh K, Van U et al. Comparing outcomes of anterior cervical discectomy and fusion in workmanʼs versus non-workmanʼs compensation population. Spine J 2002; 2: 408-414
33 Gore DR, Sepic SB. Anterior discectomy and fusion for painful cervical disc disease: A report of 50 patients with an average follow-up of 21 years. Spine 1998; 23: 2047-2051
34 Korge A, Siepe CJ, Heider F et al. Zervikaler Bandscheibenersatz – implantatspezifische Zugänge: Kielimplantat (Prodisc-C Bandscheibenprothese). Oper Orthop Traumatol 2010; 22: 480-494
35 Riew KD, Schenk-Kisser JM, Skelly AC. Adjacent segment disease and C-ADR: promises fulfilled?. Evid Based Spine Care J 2012; 3 (Suppl. 01) 39-46
36 Heller JG, Sasso RC, Papadopoulos SM et al. Comparison of Bryan cervical disc arthroplasty with anterior cervical decompression and fusion: Clinical and radiographic results of a randomized, controlled, clinical trial. Spine 2009; 34: 101-107
37 Nabhan A, Ahlhelm F, Shariat K et al. The ProDisc-C prosthesis: Clinical and radiological experience 1 year after surgery. Spine 2007; 32: 1935-1941
38 Phillips FM, Allen TR, Regan JJ et al. Cervical disc replacement in patients with and without previous adjacent level fusion surgery. Spine 2009; 34: 556-565
39 Mehren C, Suchomel P, Grochulla F et al. Heterotopic ossification in total cervical artificial disc replacement. Spine 2006; 31: 2802-2806
40 Peng CW, Quirnoa M, Bendo JA et al. Effect of intervertebral disc height on postoperative motion and clinical outcomes after ProDisc-C cervical disc replacement. Spine J 2009; 9: 551-555
41 Sasso RC, Smucker JD, Hacker RJ et al. Artificial disc versus fusion. A prospective, randomized study with 2-year follow-up on 99 patients. Spine 2007; 32: 2933-2940
42 Mummaneni PV, Amin BY, Wu JC et al. Cervical artificial disc replacement versus fusion in the cervical spine: a systematic review comparing long-term follow-up results from two FDA trials. Evid Based Spine Care J 2012; 3 (Suppl. 01) 59-66
43 Anderson PA, Sasso RC, Metcalf NH et al. Reoperation rates for cervical arthroplasty vs. arthrodesis. Spine J 2005; 5 (Suppl.) 76
44 Traynelis VC, Leigh BC, Skelly AC. Return to work rates and acitivity profiles: are there differences between those receiving C-ADR and ACDF?. Evid Based Spine Care J 2012; 3 (Suppl. 01) 47-52
45 Anderson PA, Hashimoto R. Total disc replacement in the cervical spine: a systematic review evaluating long-term safety. Evid Based Spine Care J 2012; 3 (Suppl. 01) 9-18
46 Lehmann RA, Bevevino AJ, Brewer DD et al. A systematic review of cervical artificial disc replacement wear characteristics and durability. Evid Based Spine Care J 2012; 3 (Suppl. 01) 31-38
47 Johnson JP, Filler AG, McBride DQ et al. Anterior cervical foraminotomy for unilateral radicular disease. Spine 2000; 25: 905-909
48 Yi S, Lim JH, Choi KS et al. Comparison of anterior cervical foraminotomy vs. arthroplasty for unilateral cervical radiculopathy. Surg Neurol 2009; 71: 677-680
49 Koc RK, Menku A, Tucer B et al. Anterior cervical foraminotomy for unilateral spondylotic radiculopathy. Minim Invasive Neurosurg 2004; 47: 186-189
50 Kumar GR, Maurice-Williams RS, Bradford R. Cervical foraminotomy: an effective treatment for cervical spondylotic radiculopathy. Br J Neurosurg 1998; 12: 563-568
51 Krupp W, Schattke H, Müke R. Clinical results of the foraminotomy as described by Frykholm for the treatment of lateral cervical disc herniation. Acta Neurochir (Wien) 1990; 107: 22-29
52 Rodrigues MA, Hanel RA, Prevedello DM et al. Posterior approach for soft cervical disc herniation: a neglected technique?. Surg Neurol 2001; 55: 17-22
53 Yao N, Wang C, Wang W et al. Full-endoscopic technique for anterior cervical discectomy and interbody fusion: 5-year follow-up results of 67 cases. Eur Spine J 2011; 20: 899-904
54 Ruetten S, Komp M, Merk H et al. Full-endoscopic anterior decompression versus conventional anterior decompression and fusion in cervical disc herniations. Int Orthop 2009; 33: 1677-1682
55 Ruetten S, Komp M, Merk H et al. Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. Spine 2008; 33: 940-948
56 Tzaan WC. Anterior percutaneous endoscopic cervical discectomy for cervical intervertebral disc herniation: outcome, complications, and technique. J Spinal Disord Tech 2011; 24: 421-431
57 Li J, Yan DL, Zhang ZH. Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation. Eur Spine J 2008; 17: 1664-1669
58 Yan D, Li J, Zhu H et al. Percutaneous cervical nucleoplasty and percutaneous cervical discectomy treatments of the contained cervical disc herniation. Arch Orthop Trauma Surg 2010; 130: 1371-1376
59 Zeidman SM, Ducker TB, Raycroft J. Trends and complications in cervical spine surgery: 1989–1993. J Spinal Disord 1997; 12: 523-526
60 Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine 2002; 27: 2453-2458
61 Kilburg C, Sullivan HG, Mathiason MA. Effect of approach side during anterior cervical discectomy and fusion on the incidence of recurrent laryngeal nerve injury. J Neurosurg Spine 2006; 4: 273-277
62 Beutler WJ, Sweeney CA, Connolly PJ. Recurrent laryngeal nerve injury with anterior cervical spine surgery risk with laterality of surgical approach. Spine 2001; 26: 1337-1342
63 Forsythe M, Rothman RH. New concepts in the diagnosis and treatment of infections of the cervical spine. Orthop Clin North Am 1978; 9: 1039-1051
64 Malawski SK, Lukawski S. Pyogenic infection of the spine. Clin Orthop 1991; 272: 58-66
65 Spanu G, Marchionni M, Adinolfi D et al. Complications following anterior cervical spine surgery for disc diseases: an analysis of ten years experience. Chir Organi Mov 2005; 90: 229-240
66 Bertalanffy H, Eggert HR. Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Acta Neurochir 1989; 99: 41-50
67 Fountas KN, Kapsalaki EZ, Smith BE et al. Interobservational variation in determining fusion rates in anterior cervical discectomy and fusion procedures. Eur Spine J 2007; 16: 39-45
68 Newhouse KE, Lindsey RW, Clark CR et al. Esophageal perforation following anterior cervical spine surgery. Spine 1989; 14: 1051-1053
69 Flynn T. Neurologic complications of anterior cervical interbody fusion. Spine 1982; 7: 536-539
70 Yue WM, Brodner W, Highland TR. Persistent swallowing and voice problems after anterior cervical discectomy and fusion with allograft and plating: A 5- to 11-year follow-up study. Eur Spine J 2005; 14: 677-682
71 Hannallah D, Lee J, Khan M et al. Cerebrospinal fluid leaks following cervical spine surgery. JBJS AM 2008; 90: 1101-1105
72 Vastmans J, Vogel M, Högel F et al. Verletzungen des Rückenmarks. Orthop Unfallchir up2date 2009; 6: 367-394
73 Meier O, Zenner J, Ferraris L et al. Subaxiale degenerative Instabilität und spondylotische Myelopathie. Orthop Unfallchir up2date 2011; 2: 99-116