Verletzungen der thorakolumbalen Wirbelsäule: Konservative und operative Therapie

Zusammenfassung

Verletzungen der Brust- und Lendenwirbelsäule des knochengesunden Patienten entstehen meist durch große Gewalteinwirkung. Höhe und Vektor der einwirkenden Energie beeinflussen hierbei maßgeblich das Verletzungsmuster der Wirbelsäule, welches von der einfachen Kompressionsfraktur bis hin zur Luxationsfraktur mit neurologischen Defiziten reichen kann. Die Schwere der Verletzung und patientenindividuelle Faktoren bestimmen das therapeutische Prozedere. Während einfache Verletzungen ohne Fehlstellungen eine Domäne der konservativen Therapie sind, erfordern komplexe Luxationsfrakturen häufig eine mehrzeitige Stabilisierung und Rekonstruktion der vorderen und hinteren Säule. Anspruchsvoll kann jedoch auch das Erkennen nicht offensichtlicher Instabilitäten bei intermediären Verletzungsmustern sein, deren korrekte Therapie sich häufig erst nach erweiterter Bildgebung und sorgfältiger Befundinterpretation festlegen lässt.

Unzureichende Diagnostik und Missinterpretation von Befunden führen zu Fehlbehandlungen, welche in chronischen Instabilitäten und Fehlstellungen münden können. Der folgende Artikel hat das Ziel, einen aktuellen Überblick über die verschiedenen Behandlungsaspekte der verletzten Brust- und Lendenwirbelsäule zu geben.

Abstract

Injuries of the thoracic and lumbar spine in patients who are not suffering from bone disease are usually the result of high energy trauma. The amount of energy and the vector of the impact significantly determine the injury pattern, which can reach from simple vertebral body compression to severe fracture dislocation with neurologic impairment. The magnitude of the injury as well as individual patient characteristics have an influence on the further treatment. Simple fractures with non or minor dislocation are a domain of conservative treatment, while complex injury patterns often require a two-staged stabilization and reconstruction of the anterior and posterior column of the spine. Likewise, the assessment of intermediate injuries with unapparent instability can be demanding. In these cases, determining the appropriate therapy may take further imaging and accurate evaluation of the results.

Insufficient diagnostics and wrong interpretation of findings lead to inadequate therapy which can result in chronic instability or false posture. This article has the agenda to outline the current state of diagnostics and therapy of the injured thoracic and lumbar spine.

Schlüsselwörter

Brustwirbelsäule - Lendenwirbelsäule - Fraktur - konservativ - operativ

Keywords

thoracic spine - lumbar spine - fracture - non-operative - operative

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