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DOI: 10.1055/s-0037-1618023
Zervikale Manifestation der rheumatoiden Arthritis
Diagnostik und TherapieCervical manifestation of rheumatoid arthritisDiagnosis and therapyPublication History
Publication Date:
26 December 2017 (online)
Zusammenfassung
Die zervikale Manifestation der rheumatoiden Arthritis (RA) ist häufig und wird in ihrer Bedeutung für den Rheumakranken immer noch unterschätzt. 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 jederzeit 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, die im günstigsten Fall auf die Fusion des atlantoaxialen Bewegungssegments beschränkt werden kann. Bei fortgeschrittenen zervikalen Destruktionen sind langstreckige Fusionen vom Okziput bis zur oberen Brustwirbelsäule notwendig. Moderne operative Techniken und Implantatsysteme ermöglichen diese komplexen Eingriffe auch bei fortgeschrittenem Krankheitsverlauf und erhöhter Komorbidität des Rheumakranken.
Summary
The involvement of the cervical spine in rheumatoid arthritis (RA) is common and the importance for the patient is still often underestimated. Pathophysiological changes begin with an isolated atlantoaxial subluxation (AAS) and may progress to a complex craniocervical and subaxial instability. The onset of cervical myelopathy can occur at any time and leads to a deterioration of the prognosis for the patient. 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. In case of isolated ASS, posterior atlantoaxial fusion is the treatment of choice. More complex instabilities may require a longer fusion from the occiput to the upper thoracic spine. Modern techniques and implant systems make this complex surgery also possible in severely disabled patients with a high co-morbidity.
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