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

Authors

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

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

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