Verletzungen der oberen Halswirbelsäule

Zusammenfassung

Durch ihre komplexe Funktion und Anatomie ist es sinnvoll die axiale Halswirbelsäule von der subaxialen zu unterscheiden. Verletzungen dieser Region sind vielfältig und nicht immer einfach zu diagnostizieren. Hilfreich für die Indikationsstellung zur bildgebenden Diagnostik sind die Canadian C-Spine-Rules.

Einfache Frakturen können mittels Zervikalorthese konservativ behandelt werden. Die Halotraktion ist für alle Verletzungsentitäten bis auf die transdentale C1/C2-Instabilität eine semikonservative Behandlunsgsoption.

Instabile Verletzungen bedürfen einer operativen Intervention. Für eine differenzierte Therapieentscheidung sind die vielfältigen Klassifikationssysteme hilfreich. Neben der Darstellung der bewährten Einteilungsprinzipien liegt in besonderes Augenmerk in diesem Aufsatz auf der jüngst veröffentlichten AOSpine Upper Cervical Spine Injury Klassifikation. Diese propagiert eine stärker segmentbezogene Denkweise und stellt einen sehr attraktiven Ansatz dar, da sich aus den Zuordnungen relativ einfach therapeutische Konsequenzen ableiten lassen. Sehr viele spezifische Aspekte der etablierten Klassifikationssysteme sind ebenfalls über Modifikatoren mit abbildbar.

Es werden typische Verletzungsmuster von der Diagnostik über Indikationsstellung bis hin zur Therapie dargestellt. Hervorzuheben sind hierbei die Goel/Harms-Verschraubung, die transartikuläre Verschraubung nach Magerl, die aszendierende Densosteosynthese und die Okzipitozervikale Fusion.

Abstract

Due to its complex function and anatomy, it is useful to distinguish the axial cervical spine from the subaxial spine. Injuries in this region are varied and not always easy to diagnose. The Canadian C-spine rules are helpful in determining the indication for diagnostic imaging. Simple fractures can be treated conservatively using a cervical orthosis. Halotraction is a semi-conservative treatment option for all injury entities except transdental C1/C2 instability. Unstable injuries require surgical intervention. The various classification systems are helpful for a differentiated treatment decision. In addition to presenting the proven classification principles, this article focuses in particular on the recently published AOSpine Upper Cervical Spine Injury Classification. This propagates a more segment-related way of thinking and represents a very attractive approach, as therapeutic consequences can be derived relatively easily from the classifications. Many specific aspects of the established classification systems can also be mapped using modifiers, and typical injury patterns are presented, from diagnosis and indication through to treatment. The Goel/Harms screw fixation, the transarticular screw fixation according to Magerl, the ascending densosteosynthesis and the occipitocervical fusion should be emphasized here.

Schlüsselwörter

obere Halswirbelsäule - Verletzung - Behandlung - Klassifikation

Keywords

upper cervical spine - injury - treatment - classification

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