Therapeutisch stehen konservative und operative Therapiemöglichkeiten zur Verfügung;
abhängig von den vorliegenden Beschwerden sollte bei fehlendem neurologischem Defizit
eine mindestens 3-monatige konservative Therapie vor einer operativen Maßnahme durchgeführt
werden.
In der operativen Behandlung stehen 2 Verfahrensgruppen zur Verfügung: Die ventrale
zervikale Dekompression mit Diskektomie und ggf. Korporektomie sowie dorsale Verfahren,
hier insbesondere zu erwähnen die zervikale Laminoplastie. Bei ventralen Verfahren
werden die stenosierenden Strukturen reseziert und das Myelon entlastet, Kyphosen
werden korrigiert und das Ergebnis durch eine Plattenosteosynthese gesichert. Dorsale
Verfahren entlasten das Rückenmark, indem stenosierende Prozesse entfernt werden und
der Spinalkanal nach dorsal eröffnet wird, sodass sich das Rückenmark von ventralen
Stenosierungen abheben kann; dieses Verfahren ohne Instrumentierung kann nur angewendet
werden, wenn keine zervikale Kyphose besteht. Dorsale Laminoplastieverfahren bieten
die Möglichkeit, gelenkerhaltend vorzugehen, allerdings mit der Gefahr einer Instabilität
und Kyphosierung, sodass eine genaue präoperative Evaluierung unabdingbar ist.
Entscheidend für das Gesamtergebnis bleibt die sorgfältige Indikationsstellung und
Patientenselektion sowie eine gründliche Dekompression mit solider Rekonstruktion.
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Dr. O. Meier
Werner-Wicker-Klinik
Orthopädisches Schwerpunktklinikum
Werner Wicker KG
Im Kreuzfeld 4
34537 Bad Wildungen-Reinhardshausen
Phone: 05621/803–0
Fax: 05621/803–208
Email: mitrenga@werner-wicker-klinik.de
