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Aktuelle Rheumatologie 2016; 41(06): 455-461
DOI: 10.1055/s-0042-106166
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Zervikale Wirbelsäulenchirurgie des Rheumatikers

Cervical Spinal Surgery in Rheumatic Patients
R. Kothe
1   Klinik für Spinale Chirurgie, Schön Klinik Hamburg-Eilbek, Hamburg
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Publication History

Publication Date:
22 November 2016 (online)

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Zusammenfassung

Die zervikale Manifestation der rheumatoiden Arthritis (RA) ist auch im Zeitalter der Biologika weiterhin von klinischer Bedeutung. Die typischen pathophysiologischen Veränderungen reichen von der isolierten atlantoaxialen Subluxation (ASS) bis hin zur komplexen kraniozervikalen und subaxialen Instabilität. Das Auftreten einer zervikalen Myelopathie ist in jedem Stadium möglich und für den Betroffenen mit einer deutlichen Verschlechterung der weiteren Prognose verbunden. Die Therapie der rheumatischen Halswirbelsäule hat neben der Verbesserung der subjektiven Beschwerdesymptomatik vor allem den Stopp des progredienten Krankheitsverlaufes zum Ziel. Letzteres ist nur durch eine operative Behandlung möglich, welche im günstigsten Fall auf die Fusion des atlantoaxialen Bewegungssegmentes beschränkt werden kann. Durch den zunehmenden Einsatz der Biologika haben sich die klinischen Erscheinungsbilder verändert. Patienten mit einer isolierten atlantoaxialen Instabilität sind seltener geworden. Dafür sind Patienten mit komplexen rheumatischen Deformitäten und neurologischen Problemen vermehrt in den klinischen Fokus gerückt. Bei fortgeschrittenen zervikalen Destruktionen sind langstreckige Fusionen vom Okkziput bis in die obere BWS notwendig. Die aktuellen operativen Techniken ermöglichen diese komplexen Eingriffe auch bei fortgeschrittenem Krankheitsverlauf und erhöhter Co-Morbidität des Rheumakranken.

Abstract

The involvement of the cervical spine in rheumatoid arthritis (RA) is of continued clinical importance despite the introduction of biological agents. Pathophysiological changes begin with isolated atlantoaxial subluxation (AAS) and may progress to complex craniocervical and subaxial instability. Cervical myelopathy can occur at any time and leads to a significant deterioration of the prognosis of affected patients. Treatment of the rheumatoid cervical spine should be based on the improvement of the symptoms and the prevention of further progress of the disease. The latter is only possible by surgical treatment, which, under the most favourable conditions, only consists of posterior atlantoaxial fusion. The increasing usage of biological agents has led to a change in the clinical picture of cervical involvement in RA patients. There are fewer patients presenting with isolated atlantoaxial instability. In contrast, the number of patients with complex rheumatic deformities and neurological problems is increasing. Advanced cervical destruction requires a longer fusion from the occiput to the upper thoracic spine. Thanks to modern operation techniques, this complex surgery is also possible in progressive disease stages and patients with a high level of comorbidity.

Schlüsselwörter

Rheumatoide Arthritis - Halswirbelsäule - Zervikale Myelopathie - Chirurgische Therapie

Key words

rheumatoid arthritis - cervical spine - cervical myelopathy - surgical treatment
 

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