Effektivität konservativer Behandlungsstrategien bei zervikaler Stenose - Pathophysiologie, klinische Präsentation und Evidenz für konservative Behandlung

Zusammenfassung

Das Ziel dieses Literaturreviews bestand darin, die Evidenz für die konservative Behandlung bei zervikaler Spinalstenose zu untersuchen und einen kurzen Überblick über Pathogenese und klinische Präsentation zu geben. Da die Studien, die die Effektivität von Chirurgie und Physiotherapie verglichen, verschiedene Behandlungsmodalitäten anwendeten oder gar nicht nannten, lassen sich keine Schlussfolgerungen über die Effektivität der untersuchten Strategien ziehen.

Physiotherapeuten müssen daher eine umfassende und gründliche subjektive und objektive Untersuchung durchführen, um die Ursache der Symptome aufzuspüren und die angemessene Behandlung zu verabreichen. Dabei werden sie von einem in die patientenzentrierte Behandlung integrierten kontinuierlichen Prozess des Clinical Reasoning geleitet.

Insgesamt besteht eine allgemeine Übereinstimmung darüber, dass bei leichten bis moderaten Krankheitspräsentationen eine konservative Behandlung indiziert ist. Zukünftige Studien sollten jedoch mehr Nachdruck auf die unterschiedlichen konservativen Behandlungsmodalitäten legen, um die Effektivität derselben noch genauer zu beleuchten.

Abstract

The aim of this literature review was to investigate the evidence for conservative treatment in cervical spinal stenosis and to give a short overview on the pathogenesis and clinical presentation. As studies comparing the effectiveness of surgery and physiotherapy applied different treatment modalities or did not mention them at all it is not possible to draw any conclusion about the effectiveness of the investigated strategies.

Physiotherapists have to carry out a comprehensive and systematic examination in order to detect the source of symptoms and to apply the adequate treatment. In this process they are guided by a continuous clinical reasoning process integrating a patient-centred overall management.

Overall there is general agreement that in mild to moderate presentations of the disease, conservative treatment is indicated. However, future studies should put more emphasis on different conservative treatment modalities in order to get a better sort of idea about the efficiency of these modalities.

zervikale Stenose - zervikale Spondylose - zervikale spondylotische Myelopathie - zervikale spondylotische Radikulopathie - konservative Behandlung

cervical stenosis - cervical spondylosis - cervical spondylotic myelopathy - cervical spondylotic radiculopathy - conservative management

Literatur

• 1 Barnes M P, Saunders M. The effect of cervical mobility on the natural history of cervical spondylotic myelopathy.  J Neurol Neurosurch Psychiatry. 1984;  471 17-20
• 2 Bednarik J, Kadanka Z, Vohanka S. et al . The value of Somatosensory- and Motor-Evoked Potentials in Predicting and Monitoring the Effect of Therapy in Spondylotic Cervical Myelopathy.  Spine. 1999;  24 1593-1598
• 3 Braakman R. Management of cevical spondylotic myelopathy and radiculopathy.  J of Neurology Neurosurgery and Psychiatry. 1994;  57 257-263
• 4 Bush K, Chaudhuri R, Hillier S. et al . The pathomorphologic changes that accompany the resolution of cervical radiculopathy. A prospective study with repeat magnetic resonance imaging.  Spine. 1997;  22 183-187
• 5 Crombie I. The Pocket Guide to Critical Appraisal. London; BMJ 1999 4th ed
• 6 Davidson R I, Dunn D J, Metzmaker J N. The shoulder abduction test in the diagnosis of radicular pain in cervical extradural compression monoradiculopathies.  Spine. 1981;  6 441-446
• 7 Elvey R L. Physical Evaluation of the Peripheral Nervous System in Disorders of Pain and Dysfunction.  J of Hand Therapy. 1997;  10 122-129
• 8 Escalas de Resultados . , www.tdx.cbuc.es/TESIS_UAB/AVAILABLE/TDX-1 215 104 - 165 533 //jlb3de3.pdf
• 9 Farmer J, Wisneski R J. Cervical spine nerve root compression. An analysis of neuroforaminal pressures with varying head and arm positions.  Spine. 1994;  19 1850-1855
• 10 Ferguson R JL, Caplan R. Cervical Spondylotic Myelopathy.  Neurologic Clinics. 1985;  3 373-382
• 11 Fouyas I P, Statham P FX, Sandercock P AG. Cochrane review on the role of surgery in cervical spondylotic radiculomyelopathy.  Spine. 2002;  27 736-747
• 12 Gifford L. Acute low cervical nerve root conditions: symptom presentations and pathobiological reasoning.  Manual Therapy. 2001;  6 106-115
• 13 Gifford L. Perspektive zum biopsychosozialen Modell. Teil 1: Müssen einige Aspekte vielleicht doch akzeptiert werden?.  Manuelle Therapie. 2002;  6 139-145
• 14 Gifford L. Perspektive zum biopsychosozialen Modell. Teil 2: Einkaufskorb-Ansatz.  Manuelle Therapie. 2002;  6 197-206
• 15 Gifford L. Perspektive zum biopsychosozialen Modell. Teil 3: Patientenbeispiel - Anwendung des Einkaufskorb-Ansatzes und der abgestuften Exposition.  Manuelle Therapie. 2003;  7 21-31
• 16 Hayashi H, Okada K, Hamada M. et al . Etiologic Factors of Myelopathy. A Radiographic Evaluation of the Aging Changes in the Cervical Spine.  Clinical Orthopaedics and Related Research. 1987;  214 200-209
• 17 Heckman J G, Lang C JG, Zöbelein I. et al . Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients.  Journal of Spinal Disorders. 1999;  12 396-401
• 18 Irvine D H, Foster J B, Newell D J. et al . Prevalence of cervical spondylosis in a general practice.  Lancet. 1965;  2 1089-1092
• 19 Kadanka Z. et al . Conservative treatment versus surgery in spondylotic cervical myelopathy: A prospective randomised study.  Eur Spine J. 2000;  9 538-544
• 20 Kadanka Z. et al . Approaches to Spondylotic Cervical Myelopathy. Conservative versus Surgical Results in a 3-year Follow-up Study.  Spine. 2002;  27 2205-2211
• 21 Kadanka Z, Mares M, Bendarik J. et al . Predictive factors for spondylotic cervical myelopathy treated conservatively or surgically.  European Journal of Neurology. 2005;  12 55-63
• 22 Koyanagi T, Hirabayashi K, Satomi K. et al . Predictability of Operative Results of Cervical Compression Myelopathy Based on Preoperative CT Myelography.  Spine. 1993;  14 1958-1963
• 23 LaRocca H. Cervical spondylotic myelopathy.  Spine. 1988;  13 854-855
• 24 Lestini W F, Wiesel S W. The pathogenesis of cervical spondylosis.  Clinical Orthopaedics and Related Research. 1989;  239 69-93
• 25 Macnab I. Cervical Spondylosis.  Clinical Orthopaedics and Related Research. 1975;  109 69-77
• 26 Maitland G D, Hengeveld E, Banks K. et al .Maitland’s vertebral manipulation. Oxford; Butterworth Heinemann 2001 6th ed
• 27 Matsumoto M, Toyama Y, Ishikawa M. et al . Increased Signal Intensity of the Spinal Cord on MRI in Cervical Compressive Myelopathy. Does It Predict the Outcome of Conservative Treatment?.  Spine. 2000;  6 677-682
• 28 Matsumoto M, Chiba K, Ishikawa M. et al . Relationships Between Outcomes of Conservative Treatment and Magnetic Resonance Imaging Findings in Patients With Mild Cervical Myelopathy Caused by Soft Disc Herniation.  Spine. 2001;  26 1592-1598
• 29 McCormack B M, Weinstein P R. Cervical Spondylosis. An update.  WJM. 1996;  165 43-51
• 30 McCormick W E, Steinmetz M P, Benzel E C. Cervical spondylotic myelopathy: Make the difficult diagnosis, then refer for surgery.  Cleveland Clinic Journal of Medicine. 2003;  70 899-904
• 31 Mochida K, Komori H, Okawa A. et al . Regression of cervical disc herniation observed on magnetic resonance images.  Spine. 1998;  23 990-997
• 32 Nakamura K, Kurokawa T, Hoshino Y. et al . Conservative treatment for cervical spondylotic myelopathy: Achievement and sustainability of a level of „no disability”.  Journal of Spinal Disorders. 1998;  11 175-179
• 33 PEDro Scale .Physiotherapy Evidence Database. University of Sidney. Evidence based Physiotherapy workbook. Adelaide; University of South Australia, Centre of Allied Health and Research 2001
• 34 Persson L CG, Carlsson C A, Carlsson J Y. Long-Lasting Cervical Radicular Pain Managed with Surgery, Physiotherapy, or Cervical Collar: A randomized Study.  Spine. 1997;  22 751-758
• 35 Persson L CG, Moritz U, Brandt L. et al . Cervical radiculopathy: pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar. A prospective, controlled study.  Eur Spine J. 1997;  6 256-266
• 36 Persson L CG, Lilja A. Pain, coping, emotional state and physical function in patients with chronic radicular neck pain. A comparison between patients treated with surgery, physiotherapy or neck collar - a blinded, prospective randomized study.  Disability and Rehabilitation. 2001;  23 325-335
• 37 Radhakrishan K, Litchy W J, O’Fallon W M. et al . Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990.  Brain. 1994;  117 325-335
• 38 Slipman C W, Plastaras T C, Palmitier R A. et al . Symptom provocation of fluoroscopically guided cervical nerve root stimulation: Are dynatomal maps identical to dermatomal maps?.  Spine. 1998;  23 2235-2242
• 39 Taylor J R, Twomey L. Functional and applied anatomy of the cervical spine. Grant R Physical Therapy of the Cervical and Thoracic Spine Edinbugh; Curchill Livingstone 2002 3 rd ed
• 40 Teresi L M. et al . Asymptomatic degenerative disc disease and spondylosis of the cervical spine: MR imaging.  Radiology. 1987;  164 83-88
• 41 Wainner R S, Gill H. Diagnosis and nonoperative management of cervical radiculopathy.  Journal of Orthopaedic & Sports Physical Therapy. 2000;  30 728-744
• 42 White A A, Panjabi M M. Biomechanical considerations in the surgical management of cervical spondylotic myelopathy.  Spine. 1988;  13 856-860
• 43 Yanenobu K. Cervical radiculopathy and myelopathy: When and what can surgery contribute to treatment?.  Eur Spine J. 2000;  9 1-7