Minimalinvasive Chirurgie an der Halswirbelsäule: Evidenz, Tipps und Tricks

Zusammenfassung

Analog zur Chirurgie an der Brust- und Lendenwirbelsäule, ist es auch an der Halswirbelsäule das Bestreben der minimalinvasiven-Techniken (MIS), hinsichtlich der „target surgery“ vergleichbare Ergebnisse zu den konventionellen Verfahren zu erzielen. Gleichzeitig aber die Vorteile einer weniger traumatisierenden „access surgery“ zu bieten. Im Unterschied zur BWS und LWS, kommen MIS-Techniken an der HWS überwiegend dorsal zum Einsatz. Dies reduziert nicht ihre Bedeutung, da die zervikale Muskulatur sowohl biomechanisch – Halten des Kopfgewichtes – als auch neurophysiologisch – Halten des Sehhorizonts – sehr anspruchsvolle Funktionen erfüllt. Die Notwendigkeit die zugangsbedingte Muskeltraumatisierung operativ zu minimieren ist selbsterklärend.

Im Folgenden werden bekannte operative Verfahren in einer „aktualisierten“ Version vorgestellt: Bei der posterioren Foraminotomie führt der transmuskuläre Zugang zu einer Reduktion der Zugangsmorbidität. Die Laminoplastie ist im asiatischen Raum ein etabliertes Verfahren zur Dekompression der multisegmentalen zervikalen Stenose. Die hier vorgestellte unilaterale Variante ist weniger verbreitet, entbehrt aber nicht einer klinischen Begründung. Die Ergänzung mit einer unilateralen Instrumentation erweitert das Indikationsspektrum und wird auch von Kollegen in Fernost beginnend angewendet. Die C1/C2 Instrumentation gewinnt durch die Navigation an „Standardisierung“ und somit an Sicherheit. Die subaxiale Navigation begleitet den Wandel von dem offenen zum perkutanen Einbringen von Pedikelschrauben.

Die erwähnten operativen Verfahren unterscheiden sich hinsichtlich Indikation, technischer Durchführung und Akzeptanz. Eines ist ihnen gemeinsam: Die größtmögliche operative Sicherheit mit dem Erhalt die Physiologie der Nackenmuskulatur zu vereinbaren.

Abstract

As in the thoracic and lumbar spine, MIS techniques of the cervical spine strive to achieve results comparable to those of conventional procedures in terms of “target surgery”, while at the same time offering the advantages of less traumatizing “access surgery”. However, unlike in the thoracic and lumbar spine, MIS techniques on the cervical spine are predominantly used dorsally. This does not reduce their importance, as the cervical muscles perform very demanding functions both biomechanically – holding the weight of the head – and neurophysiologically – holding the visual horizon. Thus, the need to surgically minimize access-related muscle trauma is self-explanatory.

In the following, well-known procedures such as posterior foraminotomy are presented, but in an "updated" version (transmuscular approach). Laminoplasty is in the Asian region an established procedure for decompression of multilevel cervical stenosis. The unilateral variant presented here is still not very common but does not lack clinical justification. The addition of unilateral instrumentation expands its range of indications and is also beginning to be used by colleagues in the Far East. C1/C2 instrumentation gains "standardization" and thus safety through navigation. While subaxial navigation accompanies the change from open to percutaneous insertion of pedicle screws.

The surgical procedures mentioned above differ in terms of indication, technical implementation, and acceptance. They all have one thing in common: to combine the highest possible surgical safety with the preservation of the physiology of the neck muscles.

Schlüsselwörter

Halswirbelsäule - dorsale Techniken - minimalinvasive Chirurgie - Foraminotomie - Laminoplastie

Keywords

Cervical spine - posterior techniques - minimal-invasive surgery - laminoplasty - foraminotomy

Publication History

Article published online:
24 August 2023

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