Zusammenfassung
Wirbelsäulenverletzungen, besonders bei Beteiligung des Rückenmarks und der Nervenwurzeln,
können für den Patienten erhebliche Folgen haben, bis hin zu Querschnittslähmung und
Tod im spinalen Schock. Im vorliegenden Beitrag werden neben den für die radiologische
Diagnostik wichtigen embryologischen und anatomischen Grundlagen der Wirbelsäule die
Unfallmechanismen und die daraus resultierenden typischen Verletzungsfolgen dargestellt.
Auf Sonderfälle wie die Beteiligung der Ligg. alaria und typische Verletzungsmuster
bei Kindern wird ebenso eingegangen wie auf die für die einzelnen Verletzungsmuster
wichtigen bildgebenden Verfahren. Basierend auf der aktuellen Literatur und Empfehlungen
der Fachgesellschaften wird eine Anleitung zur radiologischen Diagnostik von spinalen
Traumen gegeben. Die Vor- und Nachteile der einzelnen bildgebenden Verfahren werden
dargestellt und diskutiert.
Abstract
Spinal injuries may result in severe neurological deficits, especially if the spinal
cord or spinal nerve roots are involved. Patients may even die of a spinal shock.
Besides presenting the important embryologic and anatomical basis underlying the typical
radiological findings of spinal trauma, the trauma mechanisms and the resulting injuries
are correlated. Special situations, such as the involvement of the alar ligaments
and typical injuries in children, will be discussed as well as specific traumatic
patters relevant for imaging. Based on the actual literature and recommendations of
professional organizations, an approach is provided to the radiologic evaluation of
spinal injuries. Advantages and disadvantages of the individual imaging modalities
are presented and discussed.
Key words
Spinal trauma - Pediatric spinal injury - Conventional radiography imaging - Computed
tomography and magnetic resonance imaging - Myelogram - Alar ligaments
Literatur
- 1 Greenspan A. Skelettradiologie: Orthopädie, Traumatologie, Rheumatologie, Onkologie.
2. Aufl. Weinheim; VCH 1993
- 2
Robertson A, Branfoot T, Barlow I F, Giannoudis P V.
Spinal injury patterns resulting from car and motorcycle accidents.
Spine.
2002;
27
2825-2830
- 3
Davis J W, Phreaner D L, Hoyt D B.
The etiologiy of missed cervical spine injuries.
J Trauma.
1993;
34
342-346
- 4
Gerrelts B D, Petersen E U, Mabry J.
Delayed diagnosis of cervical spine injuries.
J Trauma.
1991;
31
1622-1626
- 5
Imhof H, Fuchsjager M.
Traumatic injuries: imaging of spinal injuries.
Eur Radiol.
2002;
12
1262-1272
- 6
King S W, Hosler B K, King M A, Eiselt E W.
Missed cervical spine fracture-dislocations: the importance of clinical and radiographic
assessment.
J Manipulative Physiol Ther.
2002;
25
263-269
- 7 Thelen M, Ritter G, Bücheler E. Radiologische Diagnostik der Verletzungen von Knochen
und Gelenken. Stuttgart; Thieme 1993: 213-260
- 8 Junghanns H.
Entwicklungsgeschichte, Anatomie und Physiologie der Wirbelsäule. In: Diebold O, Junghanns H, Zuckschwerdt L Klinische Chirurgie für die Praxis; Bewegungsapparat
und Wirbelsäule Bd. IV. Stuttgart; Thieme 1966
- 9
Hawighorst H, Berger M F, Moulin P, Zäch G A.
MRT bei spinoligamentären Verletzungen.
Orthopäde.
2001;
30
565-579
- 10 Dihlmann W. Gelenke - Wirbelverbindungen. Stuttgart; Thieme 1987
- 11 Daffner R H. Radiologische Diagnostik der Wirbelsäulenverletzungen. Stuttgart;
Thieme 1999
- 12
Anderson L D, D’Alonzo R T.
Fractures of the odontoid process of the axis.
J Bone Jt Surg.
1974;
56A
1663
- 13 Brant-Zawadzki M, Chen M Z, Moore K R, Salzman K L, Osborn A G. PocketRadiologist,
Wirbelsäule. Die 100 Top Diagnosen. München; Urban & Fischer 2002: 61-98
- 14 Hohmann G, Hackenbroch M, Lindemann K. Orthopädie in Praxis und Klinik Bd. V/Teil
2. Stuttgart; Thieme 1994: 316
- 15
Pfirrmann C WA, Binkert C A, Zanetti M, Boos , N , Hodler J.
MR Morphology of Alar Ligaments and Occipitoatlantoaxial Joints: Study in 50 Asymptomatic
Subjects.
Radiology.
2001;
218
133-137
- 16 Friedburg H, Nagelmüller T.
Welchen Beitrag vermögen CT und MRT zur posttraumatischen Beurteilung der Kopf-Hals-Region
zu liefern?. In: Graf, Baumann, Lohse, Busch (Hrsg) Weichteildistorsionen der oberen Halswirbelsäule.
Anatomie, Neurophysiologie, Diagnostik, Therapie und Begutachtung. Heidelberg; Springer
1997: 135-151
- 17
Kiwerski J.
The influence of the mechanism of cervical spine injuries on the degree of spinal
cord lesion.
Paraplegia.
1991;
29
531-536
- 18
Miller M D, Gehweiler J A, Martinez S.
Significant new observation on cervical spine trauma.
AJR.
1978;
130
655-663
- 19
Rommel O, Niedeggen A, Tegenthoff M, Kiwitt P, Botel U, Malin J.
Carotid and vertebral artery injury following severe head or cervical spine trauma.
Cerebrovasc Dis.
1999;
9
202-209
- 20
Rabinovici R, Ovadia P, Mathiak G, Abdullah F.
Abdominal injuries associated with lumbar spine fractures in blunt trauma.
Injury.
1999;
30
471-474
- 21
Holly L T, Kelly D F, Counelis G J, Blinman T, McArthur D L, Cryer H G.
Cervical spine trauma with moderate and severe head injury: incidence, risk factors,
an injury characteristics.
J Neurosurg.
2002;
96
285-291
- 22
Webb J C, Munishi P, Saifuddin A, Birch R.
The prevalence of spinal trauma associated with brachial plexus injuries.
Injury.
2002;
33
587-590
- 23
Roche C, Carty H.
Spinal trauma in children.
Pediatr Radiol.
2001;
31
677-700
- 24
Patel J C, Tepas J J, Mollitt D L, Pieper P.
Pediatric cervical spine injuries: defining the disease.
J Pediatr Surg.
2001;
36
373-376
- 25
Reynolds R.
Pediatric spinal injur.
Curr Opin Pediatr.
2000;
12
67-71
- 26
Keenan H T, Hollingshead M C, Chung C J, Ziglar M K.
Using CT of the cervical spine for early evaluation of pediatric patients with head
trauma.
Am J Roentgenol.
2001;
177
1405-1409
- 27
Orhun H, Saka G, Berkel T.
Injury to the spinal cord without any radiographic abnormality in a child.
Acta Orthop Traumatol Turc.
2002;
36
268-272
- 28
Bosch P P, Vogt M T, Ward W T.
Pediatric spinal cord injury without radiographic abnormality (SCIWORA): the absence
of occult instability and lack of indication for bracing.
Spine.
2002;
27
2788-2800
- 29
Powell J N, Waddell J P, Tucker W S.
Multiple level non contigous spinal injury.
J Trauma.
1989;
29
1146-1151
- 30
Madhaven P, Monk J, Wilson-MacDonald .
Instability due to unrecognized fracture-subluxations after apparently isolatet injuries
of the cervical spine.
J Bone Joint Surg Br.
2001;
83
486-490
- 31
Corr P, Govender S.
The role of magnetic resonance imaging on spinal trauma.
Clin Radiol.
1999;
54
629-635
- 32
Maiman D J, Yoganandam N.
Biomechanics of cervical spine trauma.
Clin Neurosurg.
1991;
37
543-570
- 33 White A A, Panajabi M M. Clinical biomechanics of the spine. 2nd ed. Philadelphia;
JB Lippincott 1990
- 34
Mazur J M, Stauffer E S.
Unrecognized spinal instability associated with seemingly „simple” cervical comprehension
fractures.
Spine.
1983;
8
687-692
- 35 Freyschmidt J. Skeletterkrankungen. Heidelberg; Springer 1993: 41
- 36
Griffen M M, Frykberg E R, Kerwin A J, Schinco M A, Tepas J J, Rowe K, Abboud J.
Radiographic clearance of blunt cervical spine injury: plain radiograph or computed
tomography scan?.
J Trauma.
2003;
55
222-226
- 37
Besman A, Kaban J, Jacobs L, Jacobs L M.
False negative plain cervical spine x-rays in blunt trauma.
Am Surg.
2003;
69
1010-1014
- 38
Messmer P, Löw R, Jacob A L.
Interdisziplinäres Management von polytraumatisierten Patienten: Beitrag der Radiologie.
Radiologie up2date.
2001;
3
275-295
- 39
Rieger M, Sparr H, Esterhammer R, Fink C, Bale R, Czermak B, Jaschke W.
Modern CT diagnosis of acute thoracic and abdominal trauma.
Anaesthesist.
2002;
51
835-842
- 40
Wintermark M, Mouhsine E, Theumann N, Mordasini P, Van Melle G, Leyvraz P F, Schnyder P.
Thoraco-lumbar spine fractures in patients who have sustained severe trauma: depiction
with multi-detector row CT.
Emerg Radiol.
2003;
3
681
- 41
Blackmore C L, Ramsey S D, Mann F A, Deyo R A.
Cervical spine screening with CT in trauma patients: a cost-effectiveness analysis.
Radiology.
1999;
212
117-125
- 42
Hauser C J, Visvikis G, Hinrichs C, Eber C D, Cho K, Lavery R F, Livingston D H.
Prospective validation of computed tomographic screening of the thoracolumbar spine
in trauma.
J Trauma.
2003;
55
228-234
- 43
Nuñez D B, Ahmad A A, Coin C G.
Clearing of the cervical spine in multiple trauma victims; a time-effective protocol
using helical computed tomography.
Emerg Radiol.
1994;
1
273-278
- 44
Schäfer D M, Flanders A E, Osterholm J L, Northrup B E.
Prognostic influence of magnetic resonance imaging in the acute phase of cervical
spine injury.
J Neurosurg.
1992;
173
219-224
- 45
Terk M R, Hume-Neal M, Fraipont M.
Injury of the posterior ligament complex in patients with acute trauma: evaluation
by MR imaging.
AJR.
1997;
168
1481-1486
- 46
Doran S E, Papadopoulos M, Ducker T, Lillehei K O.
Magnetic resonance imaging documentation of coexistent traumatic locked facets of
the cervical spine and disc herniation.
J Neurosurg.
1993;
79
341-345
- 47
Garza-Mercado R.
Traumatic extradural hematoma of the cervical spine.
Neurosurgery.
1989;
24
410-414
- 48
Matsunaga S, Sakou T, Hayashi K, Ishidou Y, Hirotsu M, Komiya S.
Trauma-induced myelopathy with ossification of the posterior longitudinal ligament.
J Neurosurg.
2002;
97
172-175
- 49
Denis F.
The three column spine and its significance in the classification of acute thoraco-lumbar
spinal injuries.
Spine.
1983;
8
817-831
- 50
Jend H, Heller M.
Stabilitätsbeurteilung bei Wirbelsäulenfrakturen.
Fortschr Röntgenstr.
1989;
151
63-68
- 51
Magerl F, Aebi A, Gertzbin S D, Harms J, Nazarian S.
A comprehensive classification of the thoracic and lumbar injuries.
Eur Spine J.
1994;
3
184-201
- 52
Exadaktylos A K, Sclabas G, Eggli S, Schonfeld H, Gygax E, Zimmermann H.
Paragliding accidents - the spine is at risk. A study from a Swiss Trauma Centre.
Eur J Emerg Med.
2003;
10
27-29
- 53
Dai L.
Imaging diagnosis of cervical spine and spinal cord injuries in children.
Chin J Traumatol.
2001;
4
222-225
- 54
Hasler C, Jeanneret B.
Wirbelsäulenverletzungen im Wachstumsalter.
Orthopäde.
2002;
31
65-73
- 55
Cayli S R, Kocak A, Kutlu R, Tekiner A.
Spinal pneumorrhachis.
Br J Neurosurg.
2003;
17
72-74
- 56
Kafadar A, Gencosmanoglu B E, Hanci M.
A great misfortune: second traumatic spinal cord injury.
Spinal Cord.
2002;
40
37-39
Dr. med. Uwe Heinemann
Klinikum Aschaffenburg · Inst. für Radiologie und Neuroradiologie
Am Hasenkopf 1 · 63736 Aschaffenburg
Phone: +49(0)6021 32-3141
Fax: +49(0)6021 32-3105
Email: u.968h@onlinehome.de
