Metastasen der Brustwirbelsäule: interdisziplinäre chirurgische Strategien zwischen Thoraxchirurgie und Neurochirurgie

Zusammenfassung

Metastasen der Brustwirbelsäule sind eine häufige Manifestation fortgeschrittener maligner Erkrankungen und erfordern teilweise ein interdisziplinäres Management. Aufgrund der komplexen anatomischen Verhältnisse im thorakalen Bereich, insbesondere der Nähe zu Mediastinalorganen, Gefäßen und dem Rückenmark, ist eine präzise Planung der operativen Durchführung essenziell. Die thoraxchirurgische Expertise ist vor allem bei der Mobilisierung mediastinaler Strukturen, der Kontrolle großer Gefäße und der Herstellung eines sicheren vorderen Zugangs von zentraler Bedeutung. Insbesondere bei gleichzeitiger Beteiligung der Thoraxorgane und der spinalen Achse. Die neurochirurgische Rolle konzentriert sich auf die Dekompression neuraler Strukturen, die Entfernung tumoröser Gewebe und die biomechanische Stabilisierung der Wirbelsäule. Beide Fachdisziplinen kooperieren eng, zeitweise auch simultan im Operationssaal, um die chirurgischen, funktionellen und onkologischen Ziele zu erreichen. Fortschritte in der intraoperativen Bildgebung, der Navigation, Robotik sowie der minimalinvasiven Techniken ermöglichen heute eine individualisierte, schonendere und effektivere Behandlung als noch vor wenigen Jahren. Darüber hinaus erfordert die moderne Therapie spinaler Metastasen die Einbindung weiterer Fachrichtungen wie Onkologie, Strahlentherapie und Schmerztherapie. Studien zeigen, dass eine strukturierte interdisziplinäre Versorgung zu besseren neurologischen Outcomes, einer höheren Lebensqualität und optimierten Anschlussbehandlungen führt. Der vorliegende Artikel beleuchtet die Schnittpunkte von Thorax- und Neurochirurgie bei der operativen Versorgung thorakaler Wirbelsäulenmetastasen, analysiert etablierte Verfahren und aktuelle Entwicklungen und zeigt auf, wie durch technologische und strukturelle Innovationen eine hochwertige, patientenzentrierte Versorgung realisiert werden kann.

Abstract

Thoracic spine metastases are a common manifestation of advanced malignancies and may in some cases require interdisciplinary management. Due to the complex anatomy of the thoracic region, particularly the proximity to mediastinal organs, major vessels, and the spinal cord, precise preoperative planning and surgical execution are essential. Thoracic surgical expertise is crucial for mobilising intrathoracic structures, securing vascular control, and establishing a safe anterior surgical corridor, especially in diseases involving thoracic organs and the spine. Neurosurgery focuses on decompression of neural elements, tumour resection, and biomechanical stabilisation of the spine. Different disciplines must work closely together, often simultaneously in the operating theatre, in order to achieve surgical, functional, and oncological goals. Advances in intraoperative imaging, navigation, robotics, and minimally invasive techniques have led to more individualised, safer, and more effective procedures than previously possible. Furthermore, the modern treatment of spinal metastases requires integration of oncology, radiation therapy and pain medicine. Studies demonstrate that structured, interdisciplinary care improves neurological outcomes, enhances quality of life, and facilitates timely continuation of systemic therapies. This article highlights the surgical intersection between thoracic and neurosurgery in the management of thoracic spine metastases, analyses established and emerging techniques, and illustrates how technological and organisational innovations enable high-quality, patient-centred treatment strategies.

Schlüsselwörter

spinale Metastasen - Brustwirbelsäule - interdisziplinäre Chirurgie

Keywords

spinal metastases - thoracic spine - interdisciplinary surgery

Publikationsverlauf

Eingereicht: 01. August 2025

Angenommen nach Revision: 29. September 2025

Artikel online veröffentlicht:
21. Oktober 2025

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